艾司氯胺酮复合舒芬太尼对混合痔术后镇痛效果的临床观察  

Clinical observation on the analgesic effect of esketamine combined with sufentanil in treatment of mixed hemorrhoids

作　　者：张晓艳 袁建虎[1] 杨茜芳 富嘉馨 Zhang Xiaoyan;Yuan Jianhu;Yang Qianfang;Fu Jiaxin(Department of Anesthesiology,Beijing Rectum Hospital(Beijing Erlonglu Hospital),Beijing 100120,China)

机构地区：[1]北京市肛肠医院(北京市二龙路医院)麻醉科,北京100120

出　　处：《海军医学杂志》2022年第3期313-317,322,共6页Journal of Navy Medicine

摘　　要：目的观察不同剂量的艾司氯胺酮(esketamine,SKM)复合舒芬太尼在混合痔术后患者自控静脉镇痛(patient controlled intravenous analgesia,PCIA)中的效果。方法选取在北京市肛肠医院择期行混合痔外剥内扎术的186例患者作为研究对象,采用数字表法随机将其分为舒芬太尼组(SF组)、不同剂量的艾司氯胺酮复合舒芬太尼组(ES_(1)组和ES_(2)组),每组各62例。但研究中SF组有2例患者因麻醉效果不能满足手术需求,最后改全身麻醉而终止研究;ES_(2)组中有1例患者术后第2天因直肠出血行急诊手术而退出研究。最终,SF、ES_(1)、ES_(2)组入组的病例数分别为60、62、61例。SF组给予舒芬太尼1.5μg/kg+托烷司琼10 mg+生理盐水至120 ml,ES_(1)组、ES_(2)组在SF组的基础上分别加用0.75 mg/kg、1.5 mg/kg的艾司氯胺酮,术后均采用PCIA。记录患者术后2、4、8、12、24、48、72 h视觉模拟评分法(visual analogue scale,VAS)评分,首次按压PCIA时间,48 h内自控次数,24、48 h舒芬太尼总用量,术后48 h内首次排便VAS评分,补救镇痛例数,镇痛满意度,以及术后48 h内不良反应发生率。结果与SF组比较,术后2、4、8、12 h ES_(1)和ES_(2)组患者的VAS评分明显降低(P<0.01);与ES_(2)组比较,术后24 h SF组及ES_(1)组患者的VAS评分明显升高(P<0.01)。与SF组比较,ES_(1)、ES_(2)组患者的首次按压PCIA时间明显延长,48 h自控次数和24 h舒芬太尼总用量减少,术后48 h内首次排便VAS评分降低,补救镇痛例数减少,镇痛满意度评分明显增高(P<0.01);与ES_(1)组比较,ES_(2)组患者的术后首次按压PCIA时间延长、48 h自控次数和24 h舒芬太尼总用量均减少、术后48 h内首次排便VAS评分降低、镇痛满意度评分明显增高(P<0.01)。3组间患者的不良反应发生率比较,差异无统计学意义(P>0.05)。结论艾司氯胺酮复合舒芬太尼可以提高混合痔术后镇痛效果,减少舒芬太尼的用量,1.5 mg/kg艾司氯胺酮复合1.5μgObjective To observe the effects of different doses of esketamine hydrochloride combined with sufentanil on pa⁃tient⁃controlled intravenous analgesia after external stripping and internal ligation of mixed hemorrhoids.Methods A total of 186 pa⁃tients selected for mixed hemorrhoids external stripping and internal ligation were enrolled for study,and were randomly divided into the sufentanil group(or the SF group),the sufentanil combined with different doses of esketamine groups(the ES_(1) group and the ES_(2) group),each consisting of 62 patients.The two patients in the SF group were excluded from the study,as they failed to meet anal⁃gesic demands.One patient in the ES_(2) group withdrew from study,as he had to received emergency surgery due to hemoproctia on the second day.Finally,the patients included in the SF,ES_(1) and ES_(2) groups were respectively 60,62 and 61.The patients in the SF group were given sufentanil at dosages of 1.5μg/kg+tropisetron 10mg plus 120ml of normal saline,and the ES_(1) and ES_(2) groups re⁃ceived esketamine at dosages of 0.75 mg/kg and 1.5 mg/kg on the basis of the SF group.PCIA was applied after surgery.The scores of visual analogue scale(VAS)at 2,4,8,12,24,48,and 72 hours after surgery were recorded,the time of first PCIA pressing,the number of self⁃control pressing within 48 hours,the total consumption of sufentanil at 24 and 48 hours,the VAS scores for first defeca⁃tion within 48 hours after surgery,supplemental analgesia,analgesia satisfaction rate and the rate of adverse reactions within 48 hours after surgery were recorded as well.Results Compared with those of the SF group,the VAS scores of the ES_(1) and ES_(2) groups at 2,4,8,and 12 hours after surgery significantly reduced(P<0.01).Compared with those of the ES_(2) group,the VAS scores of the SF and ES_(1) groups at 24 hours after surgery obviously increased(P<0.01).Compared with those of the SF group,the time of first PCIA press⁃ing for the ES_(1) and ES_(2) groups markedly prolonged,the number of 48 h se

关 键 词：艾司氯胺酮 舒芬太尼 混合痔 患者自控静脉镇痛 

分 类 号：R441.1[医药卫生—诊断学]