不同剂量艾司氯胺酮复合舒芬太尼自控静脉镇痛对经腹全子宫切除患者术后睡眠质量的影响

The effect of different doses of esketamine combined with sufentanil for patient-controlled intravenous analgesia on postoperative sleep quality in patients undergoing abdominal hysterectomy

目的观察不同剂量艾司氯胺酮复合舒芬太尼在经腹全子宫切除术后患者静脉自控镇痛(PCIA)中对其睡眠质量的影响。方法回顾性分析2022年9月至2023年9月于江苏省中医院收治的62例行经腹全子宫切除术并镇痛泵中放入艾司氯胺酮的患者,选取镇痛泵中无艾司氯胺酮的31例,按照艾司氯胺酮有无以及剂量高低分为C组、低剂量组、高剂量组,C组:舒芬太尼2.5μg/kg+托烷司琼6 mg;低剂量(ES1)组:艾司氯胺酮0.5 mg/kg+舒芬太尼2.5μg/kg+托烷司琼6 mg;高剂量(ES2)组:艾司氯胺酮1 mg/kg+舒芬太尼2.5μg/kg+托烷司琼6 mg。分析3组患者术前1 d、手术当天和术后2 d的匹兹堡睡眠指数(PSQI),以及术前1 d、术后第3天晨6时血清皮质醇(Cort)浓度、术后6、12、24、48 h的静息时轻度疼痛人数占比及按压次数、不良反应发生等情况。结果ES1组术后当天及2 d的PSQI评分低于C组(P<0.05)、ES2组术后当天的PSQI的评分低于C组及ES1组(P<0.05)、术后2 d的PSQI评分低于C组(P<0.05),与ES1组差异无统计学意义,ES1组术后的Cort浓度低于C组(P<0.05),ES2组术后的Cort浓度低于C组及ES1组(P<0.05)。术后6 h轻度疼痛的人数占比ES2组最大,其他时间点差异无统计学意义。ES2组术后自控次数明显减少,48 h不良反应发生情况三者差异无统计学意义。结论艾司氯胺酮1 mg/kg复合舒芬太尼2.5μg/kg用于经腹全子宫切除术能够改善术后睡眠质量、术后镇痛效果满意。

Objective To observe the effect of different doses of esketamine combined with sufentanil on sleep quality after abdominal hysterectomy with intravenous controlled analgesia.Mesthods A retrospective study was conducted to select 62 patients who underwent abdominal hysterectomy with esketamine in the analgesia in Jiangsu Province Hospital of Traditional Chinese Medicine from September 2022 to September 2023,and 31 patients without esketamine in the controlled intravenous analgesia.The patients were divided into group C,low dose group and high dose group according to the availability and dosage of esketamine.Group C:sufentanil 2.5μg/kg+tropisetron 6 mg;lose dose group(ES1):Esketamine 0.5 mg/kg+sufentanil 2.5μg/kg+tropisetron 6 mg;high dose group(ES2):Esketamine 1 mg/kg+sufentanil 2.5μg/kg+tropisetron 6mg.Relevant patient data of three groups was analysed,including the Pittsburgh sleep quality index(PSQI)at the preoperative day,postoperative day,the second day after surgery,the serum cortisol concentration at 6 am the day before surgery and the third day after surgery;ratio of patients with mild resting pain at 6,12,24,48 hours after surgery,the number of PCIA compressions 48 hours after surgery and the occurrence of adverse reactions.Results PSQI of the ES2 at postoperative day,the second day after surgery were lower than that of the group C(P<0.05),PSQI of the ES1 group at postoperative day,the second day after surgery were lower than that of the group C(P<0.05),PSQI of the ES2 group at postoperative day were lower than that of the ES1 group(P<0.05).Serum cortisol concentration of the ES2 group were lower than that of the group C and the ES1 group(P<0.05)at the third day of the surgery,Serum cortisol concentration of the ES1 group were lower than that of the group C(P<0.05)at the third day of the surgery.The ES2 group had the highest number of postoperative mild pain at 6 hours after surgery.There was no statistical difference at other time points.The postoperative patient-controlled frequency decreased significantly in ES2 group.There was no statistical difference in the incidence of adverse reactions among the three groups(P>0.05).Conclusion 1mg/kg esketamine combined with sufentanil 2.5μg/kg for patient-controlled intravenous analgesia after abdominal hysterectomy can improve the sleep quality,and have the better postoperative analgesic effect.