腹腔镜妇科手术患者超前注射艾司氯胺酮镇痛对瑞芬太尼诱发术后痛觉过敏的影响  

Effect of analgesia with preemptive esketamine injection on postoperative hyperalgesia induced by remifentanil in patients undergoing laparoscopic gynecological surgery

作　　者：付宝军[1] 姜静静[1] 黄玉琼 林宗航[1] 李恒[1] FU Bao-jun;JIANG Jing-jing;HUANG Yu-qiong;LIN Zong-hang;LI Heng(Department of Anesthesiology,the Sixth Affiliated Hospital of Guangzhou Medical University&Qingyuan People′s Hospital,Qingyuan 511518,China)

机构地区：[1]广州医科大学附属第六医院暨清远市人民医院麻醉科,广东省清远市511518

出　　处：《广西医学》2021年第24期2907-2913,共7页Guangxi Medical Journal

基　　金：广东省医院药学研究基金(新晨舒适化医疗专项基金,2020XC41)。

摘　　要：目的探讨腹腔镜妇科手术患者超前注射艾司氯胺酮镇痛对瑞芬太尼诱发的术后痛觉过敏的影响。方法将择期行腹腔镜妇科手术治疗的200例患者随机分为舒芬太尼组(F组)、低剂量瑞芬太尼组(L组)、高剂量瑞芬太尼组(H组)、艾司氯胺酮+低剂量瑞芬太尼组(KL组)和艾司氯胺酮+高剂量瑞芬太尼组(KH组),每组40例。KL组和KH组患者麻醉诱导前30 min时静脉注射艾司氯胺酮0.25 mg/kg,其余组注射等量生理盐水;L组和KL组患者术中静脉输注瑞芬太尼0.1μg/(kg·min),H组和KH组术中静脉输注瑞芬太尼0.3μg/(kg·min),F组术中间断静脉注射舒芬太尼进行镇痛维持。比较5组患者的睁眼时间、气管导管拔除时间及术中阿托品、去氧肾上腺素使用率;记录5组患者术后20 min静态和动态疼痛数字评价量表(NRS)评分、手术切口周围区域和优势前臂内侧的机械痛敏阈值及机械痛敏面积;记录5组患者术后舒芬太尼首次使用时间及术后24 h内舒芬太尼使用量,在麻醉复苏室的Ramsay镇静评分及术后24 h内的不良反应发生情况。结果(1)5组患者术中阿托品及去氧肾上腺素的使用率差异均无统计学意义(均P>0.05),而F组患者的睁眼时间和气管导管拔除时间均长于L组、H组、KL组、KH组(均P<0.05)。(2)术后20 min,L组、H组的静态和动态疼痛NRS评分均高于F组、KL组、KH组,且H组的静态和动态疼痛NRS评分均高于L组(均P<0.05);L组、H组的手术切口周围区域及优势前臂内侧机械痛敏阈值均低于F组、KL组、KH组,机械痛敏面积均大于F组、KL组、KH组(均P<0.05)。(3)L组、H组术后舒芬太尼首次使用时间均短于F组、KL组、KH组(均P<0.05);在麻醉恢复室时及离开麻醉恢复室0~6 h、7~12 h、13~18 h时,F组、KL组的舒芬太尼使用量均少于L组、H组、KH组,且L组、KH组的舒芬太尼使用量均少于H组(均P<0.05)。(4)进入麻醉复苏室5 min时,F组的Ramsay镇静评分均高于�Objective To investigate the effect of analgesia with preemptive esketamine injection on postoperative hyperalgesia induced by remifentanil in patients undergoing laparoscopic gynecological surgery.Methods Two hundred patients scheduled for laparoscopic gynecological surgery were randomly divided into sufentanil group(group F),low-dose remifentanil group(group L),high-dose remifentanil group(group H),esketamine+low-dose remifentanil group(group KL)and esketamine+high-dose remifentanil group(group KH),with 40 cases in each group.Thirty minutes before anesthesia induction,patients in groups KL and KH were intravenously injected with 0.25 mg/kg esketamine,the remaining groups were injected with the same amount of normal saline;patients in groups L and KL received an intravenous injection of remifentanil at 0.1μg/(kg.min)intraoperatively,groups H and KH received an intravenous injection of remifentanil at 0.3μg/(kg.min)intraoperatively,and group F received an intermittent intravenous injection of sufentanil intraoperatively to maintain analgesia.The eye opening time,the tracheal catheter extubation time,and the utilization rate of atropine or phenylephrine during the operation were compared among the five groups.The static and dynamic Numerical Rating Scale(NRS)scores for pain 20 minutes after the operation,mechanical hyperalgesia thresholds and mechanical hyperalgesia areas in the regions around the surgical incision or on the medial side of the dominant forearm of the patients were recorded in the five groups.The time of the first postoperative sufentanil use,the dosage of sufentanil within 24 hours after the operation,the Ramsay sedation score in the post-anesthesia care unit,and the incidence of adverse reactions within 24 hours after the operation of the patients were recorded in the five groups.Results(1)There was no statistically significant difference in the intraoperative utilization rate of atropine or phenylephrine among the five groups(all P>0.05),whereas patients in group F had longer eye opening time

关 键 词：妇科手术 艾司氯胺酮 瑞芬太尼 痛觉过敏 镇痛 安全性 腹腔镜 

分 类 号：R614.2[医药卫生—麻醉学]