小剂量氯胺酮联合舒芬太尼自控静脉镇痛对宫颈癌患者术后抑郁情绪及并发症的影响  

Effects of Patient-Controlled Intravenous Analgesia of Low-Dose Ketamine Combined with Sufentanil on Postoperative Depression and Complications in Patients with Cervical Cancer

作　　者：姚娜娜 朱贤林 朱荣誉 谭明 张伟 吴述轩 YAO Nana;ZHU Xianlin;ZHU Rongyu;TAN Ming;ZHANG Wei;WU Shuxuan(Dept.of Anesthesiology,the Central Hospital of Enshi Tujia And Miao Autonomous Prefecture,Hubei Enshi 445000,China)

机构地区：[1]恩施土家族苗族自治州中心医院麻醉科

出　　处：《中国医院用药评价与分析》2019年第12期1471-1474,1477,共5页Evaluation and Analysis of Drug-use in Hospitals of China

基　　金：湖北省自然科学基金项目（No.2016CFB368）

摘　　要：目的:探讨小剂量氯胺酮联合舒芬太尼自控静脉镇痛(patient-controlled intravenous analgesia,PCIA)对宫颈癌患者术后抑郁情绪及并发症的影响.方法:选取2017年1月至2019年2月恩施土家族苗族自治州中心医院收治的行宫颈癌手术并行PCIA的患者134例,按照随机数字表法分为A组45例、B组42例及C组47例.A组患者采用舒芬太尼2μg/kg,B组患者采用舒芬太尼2.5μg/kg,C组患者采用舒芬太尼2μg/kg+氯胺酮5 mg/kg.观察三组患者的镇痛效果[数字分级法(numerical rating scale,NRS)]、PCIA按压次数、Ramsay镇静评分、焦虑自评量表(self-rating anxiety scale,SAS)评分、抑郁自评量表(self-rating depression scale,SDS)评分、并发症发生情况及应激指标水平[去甲肾上腺素(NE)、肾上腺素(E)及皮质醇(Cor)].结果:术后1、12和24 h,A、B及C组患者NRS评分依次降低,且C组患者的NRS评分明显少于A、B组,B组患者明显少于A组,差异均有统计学意义(P<0.05).术后24 h内,C组患者PCIA按压次数明显少于A、B组,B组患者明显少于A组;C组患者Ramsay镇静评分明显高于A、B组,B组患者明显高于A组,差异均有统计学意义(P<0.05).PCIA 24 h后,C组患者SAS、SDS评分明显低于A、B组,差异均有统计学意义(P<0.05).术后24 h内,C组患者恶心呕吐、头晕头痛及烦躁寒战的发生率明显低于A、B组,且A组患者明显低于B组,差异均有统计学意义(P<0.05).术后10 min,三组患者血清NE、E及Cor水平的差异无统计学意义(P>0.05);术后24 h,三组患者上述指标水平均出现明显降低,且C组患者明显低于A、B组,差异均有统计学意义(P<0.05).结论:小剂量氯胺酮联合舒芬太尼PCIA用于宫颈癌患者术后镇痛效果显著,可改善焦虑、抑郁情绪,减少并发症和应激反应.OBJECTIVE:To probe into the effect of patient-controlled intravenous analgesia(PCIA)of low-dose ketamine combined with sufentanil on postoperative depression and complications in patients with cervical cancer.METHODS:134 patients undergoing cervical cancer and PCIA admitted into the Central Hospital Of Enshi Tujia And Miao Autonomous Prefecture from Jan.2017 to Feb.2019 were selected and divided into group A(45 cases),group B(42 cases)and group C(47 cases)via random number table.Group A was treated with 2μg/kg of sufentanil,group B was treated with 2.5μg/kg of sufentanil,while group C was given 2μg/kg of sufentanil combined with 5 mg/kg of ketamine.The analgesic effect[numerical rating scale(NRS)],press times of PCIA,Ramsay sedation scores,self-rating anxiety scale(SAS),self-rating depression scale(SDS),incidences of complications and levels of stress indices[norepinephrine(NE),epinephrine(E)and cortisol(Cor)]of the three groups were observed.RESULTS:At 1 h,12 h and 24 h after surgery,the NRS scores of group A,group B and group C were decreased in order,the NRS score of group C was significantly less than that of group A and group B,and that of group B was significantly less than group A,with statistically significant differences(P<0.05).Within 24 h after surgery,the press times of PCIA of group C was significantly less than that of group A and group B,and that of group B was significantly less than group A;the Ramsay sedation score of gorup C was significantly higher than that of group A and group B,and that of group B was significantly higher than group A,with statistically significant differences(P<0.05).At 24 h after PCIA,the SAS and SDS scores of group C were significantly lower than those of group A and group B,with statistically significant differences(P<0.05).Within 24 h after surgery,the incidences of nausea,vomiting,vertigo,headache,anxious and shiver of group C were significantly lower than those of group A and group B,and those of group A were significantly lower than group B,with statistically sig

关 键 词：麻醉 氯胺酮 舒芬太尼 PCIA 宫颈癌 焦虑抑郁 

分 类 号：R971^+.2[医药卫生—药品]