艾司氯胺酮复合舒芬太尼在子宫肌瘤腹腔镜下剥除术后的镇痛作用

Analgesic effect of Esketamine combined with sufentanil after laparoscopic myomectomy

目的探讨艾司氯胺酮复合舒芬太尼在子宫肌瘤腹腔镜下剥除术后的镇痛作用。方法将120例行子宫肌瘤腹腔镜下剥除术的患者按随机数字表分为常规组与观察组,2组患者均予以常规全身麻醉。术后常规组患者予以舒芬太尼静脉自控镇痛,配合盐酸昂丹司琼止吐;观察组患者予以艾司氯胺酮复合舒芬太尼静脉自控镇痛,配合盐酸昂丹司琼止吐。比较2组患者镇痛泵按压次数;术后8 h、12 h、24 h、48 h评估患者静息时和活动时的疼痛视觉模拟量表(VAS)评分;比较2组患者术后清醒即刻与术后48 h机体应激反应指标水平,包括肾上腺素(E)、去甲肾上腺素(NE)、皮质醇(Cor);比较2组患者术后清醒即刻与术后48 h的心理应激反应指标,包括焦虑、抑郁程度;统计2组不良反应和爆发痛发生率。结果观察组患者镇痛泵按压次数少于常规组(P<0.05)。2组患者静息痛和活动痛VAS评分均随时间延长逐渐显著下降(P<0.05),且观察组均较常规组低(P<0.05)。观察组患者术后48 h血清E、NE和Cor水平,焦虑和抑郁评分均较术后清醒即刻降低(P<0.05),且观察组均较常规组低(P<0.05);观察组患者上述指标差值均大于常规组(P<0.05)。2组不良反应发生率无统计学差异(P>0.05)。观察组爆发痛发生率显著低于常规组(P<0.05)。结论子宫肌瘤腹腔镜下剥除术后采用艾司氯胺酮复合舒芬太尼可减少患者镇痛泵按压次数,减轻疼痛和应激反应,减少镇痛不足,且安全性较好。

Objective To explore the analgesic effect of Esketamine combined with sufentanil after laparoscopic myomectomy.Methods A total of 120 patients with laparoscopic myomectomy were divided into the routine group and the observation group according to a random number table.Patients in both groups were given routine general anesthesia.After operation,patients in the routine group were given self-controlled intravenous analgesia(sufentanil),with ondansetron hydrochloride to stop vomiting,while patients in the observation group were given self-controlled intravenous analgesia(Esketamine combined with sufentanil),with ondansetron hydrochloride to stop vomiting.The numbers of analgesia pump compressions of patients in both groups were compared.The pain visual analogue scale(VAS)score of patients at rest and activity 8 hours,12 hours,24 hours and 48 hours after operation in both groups were compared.The body stress responses of patients immediately and 48 hours after operation in both groups were compared,including adrenaline(E),norepinephrine(NE)and cortisol(Cor).The psychological stress responses of patients immediately and 48 hours after operation in both groups were compared,including anxiety and depression.The incidences of adverse reactions and outbreak pain were compared between the two groups.Results The number of analgesia pump compressions of patients in the observation group was less than that in the routine group(P<0.05).The VAS scores of patients at rest and activty in the two groups gradually decreased along with time(P<0.05),and the observation group was lower than the routine group(P<0.05).The levels of serum E,NE and Cor,anxiety and depression scores 48 hours after operation of patient in both groups were lower compared with those at immediately after surgery(P<0.05),and the observation group was lower than the routine group(P<0.05).The difference of above indicators of patients in the observation group were all higher than those in the routine group(P<0.05).There was no statistical difference in the incidence of adverse reactions between the two groups(P>0.05).The incidence of outbreak pain in the observation group was significantly lower than that in the routine group(P<0.05).Conclusion The use of Esketamine combined with sufentanil after laparoscopic myomectomy can reduce the number of analgesia pump compressions,relieve pain and stress reponse,reduce hypoanalgesia,with good safety.