艾司氯胺酮对瑞芬太尼持续输注后痛觉过敏的影响  

Effects of esketamine on hyperalgesia after continuous infusion of remifentanil

作　　者：李晓玲[1] 谢海玉[1] 袁柳青 LI Xiao-ling;XIE Hai-yu;YUAN Liu-qing(Department of Anesthesiology,the First Affiliated Hospital of Gannan Medical University,Ganzhou JIANGXI 341000,China)

机构地区：[1]赣南医学院第一附属医院麻醉科,江西赣州341000

出　　处：《中国新药与临床杂志》2022年第5期298-301,共4页Chinese Journal of New Drugs and Clinical Remedies

摘　　要：目的探讨小剂量艾司氯胺酮预防瑞芬太尼持续输注后痛觉过敏的效果。方法将拟行妇科肿瘤手术患者100例随机分为2组,每组50例。2组麻醉诱导和维持(丙泊酚联合瑞芬太尼)方法相同,手术结束前5 min,观察组给予艾司氯胺酮0.25 mg·kg^(-1),对照组给予氯化钠注射液。记录给药前、给药后5 min患者的收缩压、舒张压和心率,以及拔管时间和复苏时间。评估患者术后12 h内的疼痛阈值,记录术后24 h内药物不良反应发生情况。结果2组拔管时间比较无显著差异(P>0.05),观察组复苏时间长于对照组(P<0.05)。观察组术后30 min、2 h、4 h疼痛阈值高于对照组(P<0.05),术后6 h、12 h疼痛阈值组间比较差异无显著意义(P>0.05)。观察组给药前后血压、心率无明显变化(P>0.05)。术后24 h内对照组发生痛觉过敏8例(16%),观察组发生1例(2%),痛觉过敏发生率组间比较差异显著(P<0.05),高血压、心动过速、梦魇、呼吸抑制、恶心呕吐发生率组间比较无显著差异(P>0.05)。结论小剂量艾司氯胺酮可以降低瑞芬太尼持续输注后痛觉过敏的发生率,对患者血流动力学无明显影响,但可引起复苏时间延长。AIM To study the effects of low doses of esketamine for prevention of hyperalgesia after continuous infusion of remifentanil.METHODS A total of 100 patients undergoing gynecological tumor surgery,were randomly divided into observation group and control group,50 cases in each group.The induction and maintenance(propofol combined with remifentanil)of anesthesia were the same in both groups.Five minutes before the end of the operation,the observation group received low doses of esketamine 0.25 mg·kg^(-1),and the control group received sodium chloride injection.The time to extubation and recovery time were recorded,systolic blood pressure(SBP),diastolic blood pressure(DBP)and heart rate(HR)were also recorded before and 5 minutes after administration.Pain threshold was assessed within postoperative 12 h.The adverse drug reactions were recorded within postoperative 24 h.RESULTS There was no significance difference in extubation time between the two groups(P>0.05),but the recovery time in the observation group was longer than that in the control group(P<0.05).Pain thresholds at 30 min,2 h,4 h after operation were higher in the observation group than those in the control group(P<0.05),but there were no significance differences at 6 h,12 h after operation between the two groups(P>0.05).There were no significance changes in blood pression and heart rate after drug administration(P>0.05).There were 8 cases of hyperalgesia in the control group and 2 cases of hyperalgesia in the observation group,and significant difference was found in the incidence of postoperative hyperalgesia(P<0.05),while there were no significant difference in incidence of hypertension,tachycardia,nightmare,respiratory depression,nausea and vomiting(P>0.05).CONCLUSION Low dose of esketamine can reduce the incidence of hyperalgesia after continuous infusion of remifentanil,has no effect on hemodynamics,but may cause prolonged recovery time.

关 键 词：艾司氯胺酮 瑞芬太尼 丙泊酚 麻醉 全身 痛觉过敏 

分 类 号：R971[医药卫生—药品]