不同剂量艾司氯胺酮对瑞芬太尼持续输注诱发痛觉过敏的影响

Effects of different doses of esketamine on remifentanil-induced hyperalgesia

目的探讨不同剂量艾司氯胺酮对瑞芬太尼持续输注诱发术后痛觉过敏的影响。方法选取需在全身麻醉下行腹腔镜子宫全切手术患者90例,采用随机数字表法将其随机分为三组:艾司氯胺酮0.5 mg/kg组(H组)、艾司氯胺酮0.3 mg/kg组(L组)和对照组(C组),每组30例。H组和L组于麻醉诱导前5 min分别静脉注射相应剂量艾司氯胺酮,C组给予等容量生理盐水。分别于术前1 d、术后30 min、6 h、12 h、24 h记录切口周围区域以及非优势手前臂内侧痛阈值。分别于术后30 min、6 h、12 h和24 h记录术后痛觉过敏发生率、视觉模拟评分法(VAS)疼痛评分。记录术后不良反应发生率和补救镇痛率。结果在术后30 min、6 h和12 h C组切口周围和非优势手前臂痛阈均低于术前基线值(P<0.05),H组和L组与术前基线值比较差异无统计学意义(P>0.05);在术后30 min、6 h、12 h H组和L组切口周围和非优势手前臂痛阈均高于C组(P<0.05);术后24 h三组患者切口周围和非优势手前臂痛阈比较,差异无统计学意义(P>0.05)。术后30 min、6 h、12 h H组和L组切口周围和非优势手前臂痛觉过敏发生率均低于C组(P<0.05);H组和L组痛觉过敏发生率比较,差异无统计学意义(P>0.05)。H组和L组术后6 h、12 h VAS评分均低于C组(P<0.05)。H组谵妄幻觉和腺体分泌物发生率高于C组和L组(P<0.05)。C组补救镇痛率高于H组和L组(P<0.05)。结论麻醉诱导时静脉注射艾司氯胺酮0.5 mg/kg或0.3 mg/kg对瑞芬太尼的痛觉过敏有一定的预防作用,其中0.3 mg/kg艾司氯胺酮不良反应发生率更低。

【Objective】To explore the effect of different doses of esketamine on postoperative pain hypersensitivity induced by continuous infusion of remifentanil.【Methods】Ninety patients undergoing laparoscopic total hysterectomy under general anesthesia were randomly assigned to 1 of 3 groups:high-dose esketamine 0.5mg/kg group(Group H),low-dose esketamine 0.3 mg/kg group(Group L),and a control group(Group C).Group H and Group L were given corresponding doses of esketamine via intravenous injection 5 minutes before anesthesia induction,while Group C was given an equal volume of physiological saline.Pain threshold around the incision area and non-dominant hand medial forearm were measured at 1 day before surgery,30 minutes,6 hours,12 hours,and 24 hours after surgery.We also recorded postoperative incidence of pain hypersensitivity,pain scores,the incidence receiving rescue analgesics,and side effects up to 24 hours after surgery.【Results】The pain threshold around the skin incision and non-dominant hand medial forearm in Group C was lower than the preoperative baseline value at 30 minutes,6 hours,and 12 hours after surgery(P<0.05),while there was no statistically significant difference between Group H and Group L compared with the preoperative baseline value(P>005).At 30 minutes,6 hours,and 12 hours after surgery,the pain threshold in Group H and Group L was higher than that in Group C(P<0.05).There was no statistically significant difference in pain threshold among the three groups of patients 24 hours after surgery(P>0.05).The incidence of pain hypersensitivity in Group H and Group L was lower than that in Group C at 30 minutes,6 hours,and 12 hours after surgery(P<0.05).There was no statistically significant difference in the incidence of pain hypersensitivity between Group H and Group L.The VAS scores at 6 and 12 hours after surgery in Group H and Group L were lower than those in Group C(P<0.05).The incidence of delirium hallucinations and glandular secretions in Group H was higher than that in Group C and Group L(P<0.05).The rescue analgesia rate in Group C was higher than that in Group H and Group L(P<0.05).【Conclusion】Intravenous injection of 0.5 mg/kg or 0.3 mg/kg of esketamine during anesthesia induction has a certain preventive effect on pain hypersensitivity of remifentanil,with a lower incidence of adverse reactions for esketamine at 0.3 mg/kg.