艾司氯胺酮或纳布啡用于胸椎旁阻滞前的镇痛效果及对R-A-A-S的影响  

Analgesic effect of esketamine or nalbuphine before thoracic paravertebral block and their influences on R-A-A-S

作　　者：颜景佳[1] 黄琦萍 陈清霞[1] 苏长生 YAN Jingjia;HUANG Qiping;CHEN Qingxia;SU Changsheng(Department of Anesthesiology,Quanzhou First Hospital Affiliated to Fujian Medical University,Quanzhou,Fujian 362000,China)

机构地区：[1]福建医科大学附属泉州第一医院麻醉科,福建泉州362000

出　　处：《重庆医学》2022年第5期820-824,共5页Chongqing medicine

基　　金：福建省泉州市科技局高层次人才创新创业项目(2018C058R)。

摘　　要：目的比较亚麻醉剂量的艾司氯胺酮和纳布啡分别用于胸科手术麻醉复合超声引导下胸椎旁神经阻滞前镇痛效果和对肾素-血管紧张素-醛固酮系统(R-A-A-S)的影响。方法选择该院胸科择期行胸腔镜手术的80例患者为研究对象。根据用药不同分为艾司氯胺酮组(ES组)和纳布啡组(NB组),每组各40例。患者入手术室后均常规吸氧,监测心电图、血压、脑电双频指数(BIS)等,入室后先给予右美托咪定负荷量按0.4μg/kg的速度于10 min内进行泵注,ES组和NB组分别给予艾司氯胺酮和盐酸纳布啡静脉注射,剂量均为0.15 mg/kg,给药后5 min行神经阻滞。观察患者入手术室时(T1)、给予镇痛药后5 min(T2)、神经阻滞操作时(T3)、神经阻滞操作后5 min(T4)、手术开始时(T5)、手术开始15 min(T6)这6个时间点血压、心率、BIS水平。比较T3、T4、手术结束后入麻醉恢复室(PACU)时(T7)和出PACU时(T8)这4个时间点的疼痛模拟评分(VAS)、镇静评级、苏醒评分、舒适评分(BCS),同时比较T1、T7的R-A-A-S水平。结果两组T2、T3心率、血压比较,差异有统计学意义(P<0.05),且ES组更加稳定;两组T2 BIS值比较,差异有统计学差异(P<0.05),且NB组水平更低。ES组T3 VAS、镇静评级、苏醒评分、BCS优于NB组,ES组T4 BCS优于NB组,ES组T7、T8 VAS优于NB组,不良反应发生例数比NB组少,差异有统计学意义(P<0.05)。ES组T7血管紧张素水平明显低于NB组,差异有统计学意义(P<0.05)。结论艾司氯胺酮可用于神经阻滞前镇痛镇静,且对R-A-A-S的影响更小。Objective To compare the analgesic effect and their influences on renin-angiotensin-aldosterone system(R-A-A-S)of Esketamine and Nalbuphine in subanesthetic dose before thoracic surgery anesthesia combined with ultrasound-guided thoracic paraspinal nerve block.Methods A total of 80 patients undergoing elective thoracoscopic surgery in thoracic department were selected as the research objects.Depending on the type of medication,the patients were divided into esketamine group(ES group)and nalbuphine group(NB group),with 40 cases in each group.After entering the operating room,all the patients received routine oxygen inhalation,and were monitored for electrocardiogram,blood pressure,bispectral index(BIS)and so on.After entering the room,dexmedetomidine was pumped at a dose of 0.4 ug/kg within 10 min,and esketamine and nalbuphine hydrochloride were given intravenously to the ES and NB groups at a dose of 0.15 mg/kg respectively.The nerve block was performed five min after administration.The blood pressure,heart rate and BIS were collected and registered at six-time points:when the patient entered the operating room(T1),five min after administration of analgesics(T2),nerve block operation(T3),five min after nerve block operation(T4),operation start(T5)and operation start 15 min(T6).The Visual Analogue Score(VAS),Ramsay sedation rating(Ramsay),Steward awakening score(Steward)and comfort score(BCS)were evaluated at the time of T3,T4,when entering the post-anesthetic ICU(PACU)after operation(T7),and when leaving PACU(T8).The levels of R-A-A-S were compared between T1 and T7.Results The heart rate and blood pressure between ES group and NB group were significantly different at T2 and T3(P<0.05),and ES group was more stable.The BIS value at T2 was significantly different between the two groups(P<0.05),and the level of NB group was lower.At T3,the scores/grades of VAS,Ramsay,Steward and BCS in ES group were better than those in NB group,with the statistical difference between the two groups(P<0.05).At T4,BCS of ES group was

关 键 词：艾司氯胺酮 纳布啡 胸科手术麻醉 舒适化 超声引导下神经阻滞 R-A-A-S 

分 类 号：R614.4[医药卫生—麻醉学]