小剂量艾司氯胺酮联合舒芬太尼在腹腔镜子宫肌瘤剔除术后镇痛的应用

Application of low-dose esketamine combined with sufentanil for postoperative analgesia in laparoscopic myomectomy for uterine fibroids

目的分析小剂量艾司氯胺酮联合舒芬太尼用于腹腔镜子宫肌瘤剔除术后镇痛的效果及安全性。方法选择2020年8月—2023年8月南充市中心医院收治的98例腹腔镜子宫肌瘤剔除术患者,按照随机数表法将其均分为试验组、对照组。试验组行小剂量艾司氯胺酮联合舒芬太尼镇痛,对照组予以舒芬太尼镇痛。比较两组术后2、6、24 h生命体征、疼痛,24 h炎症应激指标,术后24 h不良反应发生情况。结果术后2、6、24 h两组平均动脉压、心率比较差异无统计学意义(P>0.05)。术后6、24 h试验组静息时和活动时视觉模拟评分分别为(1.94±0.33)、(1.35±0.40)分和(5.57±0.45)、(2.16±0.43)分,低于对照组的(3.14±0.31)、(1.93±0.43)分和(6.15±0.55)、(3.36±0.52)分(P<0.05)。术后24 h试验组血清肿瘤坏死因子-α、去甲肾上腺素、白介素-6水平分别为(15.73±2.08)g·L^(-1)、(704.84±86.32)pmol·L^(-1)、(46.52±5.28)ng·L^(-1),低于对照组的(21.18±3.17)g·L^(-1)、(753.21±85.60)pmol·L^(-1)、(53.87±6.26)ng·L^(-1)(P<0.05)。术后24 h不良反应发生率试验组更低(4.08%vs 18.37%,P<0.05)。结论小剂量艾司氯胺酮联合舒芬太尼用于腹腔镜子宫肌瘤剔除术后镇痛的效果较好,可降低机体炎症应激水平,并未对生命体征产生不良影响,还可降低不良反应发生风险。

Objective To analyze the efficacy and safety of low-dose esketamine combined with sufentanil for postoperative analgesia after laparoscopic myomectomy.Methods A total of 98 patients undergoing laparoscopic myomectomy in the affiliated hospitals of Nanchong Central Hospital from August 2020 to August 2023 were selected and randomized equally into the experimental group and the control group.The patients in the experimental group received low-dose esketamine combined with sufentanil for pain relief,while those in the control group received sufentanil only.The vital signs and pain at 2 h,6 h and 24 h after surgery,the inflammatory stress indexes before surgery and 24 h,and the occurrence of adverse reactions 24 h after surgery were compared between the two groups.Results There was no statistically significant difference in the mean artery pressure and heart rate at 2 h,6 h and 24 h after surgery between the two groups(P>0.05).The scores of visual analogue scale of the 6 h and 24 h of the experimental groups at rest and during activity were(1.94±0.33),(1.35±0.40)and(5.57±0.45),(2.16±0.43),respectively,which were lower than(3.14±0.31),(1.93±0.43)and(6.15±0.55),(3.36±0.52)of the control group(P<0.05).At 24 h after surgery,the serum levels of tumor necrosis factor-α,noadrenaline and interleukin-6 in the experimental group were(15.73±2.08)g·L^(-1),(704.84±86.32)pmol·L^(-1)and(46.52±5.28)ng·L^(-1),respectively,which were lower than(21.18±3.17)g·L^(-1),(753.21±85.60)pmol·-1L and(53.87±6.26)ng·L^(-1)of the control group(P<0.05).The incidence of adverse reactions 24 h after operation was lower in the experimental group(4.08%vs.18.37%)(P<0.05).Conclusion Low dose esketamine combined with sufentanil has good analgesic effect after laparoscopic myomectomy.Meanwhile,it can decrease the level of inflammatory stress in the body,has no adverse effects on vital signs and also reduce the risk of adverse reactions.