右美托咪定、艾司氯胺酮和利多卡因复合用药行无阿片类药物用于乳腺肿块切除术麻醉的可行性  

The feasibility of opioid-free anesthesia with combined use of dexmedetomidine, esketamine and lidocaine in breast lumpectomy

作　　者：钱夏丽 陈雅洁 冯善武[1] 王娴[1] QIAN Xiali;CHEN Yajie;FENG Shanwu(Department of Anesthesiology,Women’s Hospital of Nanjing Medical University,Nanjing Maternity and Child Health Care Hospital,Nanjing 210004,CHINA)

机构地区：[1]南京医科大学附属妇产医院(南京市妇幼保健院)麻醉科,江苏210004

出　　处：《江苏医药》2022年第2期154-157,共4页Jiangsu Medical Journal

摘　　要：目的 探讨右美托咪定、艾司氯胺酮和利多卡因复合用药行无阿片类药物麻醉在乳腺肿块切除术的可行性。方法 乳腺肿块切除术患者60例,随机均分为无阿片类药物麻醉组(A组)和常规阿片类药物麻醉组(B组),每组30例。记录两组患者入室时(T0)、麻醉诱导后即刻(T1)、插管后即刻(T2)、切皮后1 min(T3)和10 min(T4)的MAP和HR。记录两组术中血管活性药物使用情况和术后2、12和24 h的VAS疼痛评分。记录两组患者术后24 h内不良反应发生情况。结果与T0时相比,两组在T1~T4时MAP和HR均降低(P<0.05)。T1~T4时,A组患者MAP和HR均高于B组(P<0.05)。A组患者术中麻黄碱和阿托品使用率低于B组(P<0.05)。两组患者术后2、12、24 h的VAS疼痛评分比较差异无统计学意义(P>0.05)。A组患者术后恶心呕吐发生率低于B组(P<0.05),而术后分泌物增加发生率高于B组(P<0.05)。结论 右美托咪定、艾司氯胺酮和利多卡因复合用药行无阿片类药物麻醉的麻醉效果与常规阿片类药物麻醉的乳腺肿块切除术后镇痛效果相当,但前者更能维持循环稳定,降低术后恶心呕吐发生率。Objective To observe the feasibility of opioid-free anesthesia with combined use of dexmedetomidine, esketamine and lidocaine in breast lumpectomy.Methods Sixty patients underwent breast lumpectomy were randomly divided into two groups with 30 cases each.Opioid-free anesthesia with combined use of dexmedetomidine, esketamine and lidocaine was used in group A.Conventional anesthesia with opioid anesthetics was used in group B.The MAP and HR were recorded at the time points of before anesthesia(T0),immediately after anesthesia induction(T1) and after intubation(T2),at 1 minute(T3) and 10 minutes(T4) after skin incision.The use of intraoperative vasoactive drugs and VAS pain scores at 2,12,and 24 hours after surgery were recorded.The occurrence of adverse reactions within 24 hours after operation was recorded.Results Compared with T0,the MAP and HR of two groups were decreased at T1 to T4(P<0.05),which of group A were higher than those of group B(P<0.05).The use rate of ephedrine and atropine in group A was lower than that in group B(P<0.05).There was no significant difference in VAS pain scores between the two groups at the 2;,12;,and 24;hour after surgery(P>0.05).The incidence of postoperative nausea and vomiting was lower, and that of increased postoperative secretions was higher in group A than those in group B(P<0.05).Conclusion The opioid-free anesthesia with combined use of dexmedetomidine, esketamine and lidocaine has the same anesthesia and postoperative analgesia efficacy as the conventional anesthesia with opioid anesthetics in breast lumpectomy.The former has better circulation stability and lower incidence of postoperative nausea and vomiting.

关 键 词：无阿片类药物麻醉 右美托咪定 艾司氯胺酮 利多卡因 乳腺肿块切除术 

分 类 号：R614[医药卫生—麻醉学]