亚麻醉剂量艾司氯胺酮用于胸腔镜肺叶切除术镇痛效果的观察  

Sub-anesthetic dose of esketamine for analgesia in thoracoscopic lobectomy

作　　者：冯兆胜 武亚芸 梁士权 王建刚 朱健[2] 郭志佳[2] Feng Zhaosheng;Wu Yayun;Liang Shiquan;Wang Jiangang;Zhu Jian;Guo Zhijia(Department of Anesthesiology,Shanxi Medical University,Taiyuan 030001,China;Department of Anesthesiology,First Hospital of Shanxi Medical University,Taiyuan 030001,China)

机构地区：[1]山西医科大学麻醉学院,山西太原030001 [2]山西医科大学第一医院麻醉科,山西太原030001

出　　处：《实用药物与临床》2022年第12期1103-1107,共5页Practical Pharmacy and Clinical Remedies

摘　　要：目的探讨亚麻醉剂量艾司氯胺酮对胸腔镜肺叶切除术患者术后阿片类药物使用量及术后急慢性疼痛的影响。方法选择2021年10月至2022年3月在山西医科大学第一医院全麻下择期行胸腔镜肺叶切除手术者100例,按随机数字表法分为瑞芬太尼复合艾司氯胺酮组(试验组)和单纯瑞芬太尼组(对照组),每组50例。两组均实施静脉麻醉,常规诱导后泵入丙泊酚和瑞芬太尼注射液维持麻醉,试验组切皮前静脉滴注艾司氯胺酮0.25 mg/kg,术中按0.15 mg/(kg·h)持续泵注,手术结束前30 min停药;对照组给予等量生理盐水。比较两组患者术后4 h(T0)、8 h(T1)、12 h(T2)、24 h(T3)、48 h(T4)5个时间点的静息、活动后视觉模拟评分(VAS);24 h内静脉自控镇痛泵(PCIA)中舒芬太尼累计用量、首次按压镇痛泵时间、24 h内按压镇痛泵的次数;不良反应发生情况、对镇痛满意度及总体评价,记录术后1 d、1个月、3个月利兹神经病理性症状和体征疼痛评分(LANSS)。结果试验组24 h内PCIA中舒芬太尼累计用量低于对照组[(81.30±2.39)μg vs.(89.67±3.88)μg,P<0.05];试验组在术后T0、T1、T2的VAS评分明显低于对照组(P<0.05);试验组首次按压镇痛泵的时间晚于对照组[(85.46±10.76)min vs.(41.12±13.83)min,P<0.05];24 h内有效按压镇痛泵次数少于对照组[(6.20±1.59)次vs.(11.78±2.58)次,P<0.05];两组患者不良反应差异无统计学意义(P>0.05);试验组患者术后镇痛满意度、总体评价高于对照组(P<0.05);试验组术后1 d、1个月和3个月的LANSS评分均低于对照组[(11.38±2.05)分vs.(15.06±1.89)分,(8.62±1.63)分vs.(12.70±1.28)分,(6.50±1.56)分vs.(11.16±1.73)分,P<0.05]。结论术中亚麻醉剂量艾司氯胺酮可以减轻胸腔镜肺叶切除术术后患者的急性疼痛,减少术后阿片类药物的使用量,且不增加患者的不良反应,其对缓解神经病理性疼痛有一定意义。Objective To investigate the effect of a sub-anaesthetic dose of esketamine on postoperative opioid use and acute and chronic postoperative pain in patients undergoing thoracoscopic lobectomy.Methods One hundred patients who underwent elective thoracoscopic lobectomy under general anesthesia in the First Hospital of Shanxi Medical University from October 2021 to March 2022 were selected and divided into the remifentanil combined with esketamine group(test group)and the remifentanil alone group(control group)according to the random number table method,with 50 cases in each group.Both groups were given intravenous anesthesia,and propofol and remifentanil injections were pumped to maintain anesthesia after routine induction.In the test group,esketamine was administered intravenously at 0.25 mg/kg before skin incision and continuously pumped at 0.15 mg/(kg·h)during the operation,and stopped 30 minutes before the end of the operation.The control group was given the same volume of normal saline.The two groups of patients were compared in terms of resting and post-active visual analogue scores(VAS)at 4 h(T0),8 h(T1),12 h(T2),24 h(T3)and 48 h(T4)postoperatively,the cumulative amount of sufentanil in the intravenous self-administered analgesia(PCIA)pump,the time of first pump press,the number of pump presses within 24 hours,the occurrence of adverse reactions,satisfaction with analgesia and overall evaluation.Leeds Neuropathic Symptoms and Signs Pain Score(LANSS)were recorded at 1 day,1 month and 3 months postoperatively.Results The cumulative amount of sufentanil in the PCIA was(81.30±2.39)μg in 24 h in the test group compared with(89.67±3.88)μg in the control group(P<0.05).The VAS scores at T0,T1 and T2 in the test group were significantly lower than those in the control group(P<0.05).In the test group,the time of first press of the pain pump was later,compared to the control group[(85.46±10.76)min vs.(41.12±13.83)min,P<0.05],and the effective press of the pain pump in 24 h was less[(6.20±1.59)vs.(11.78±2.58),P

关 键 词：艾司氯胺酮 疼痛管理 胸腔镜外科手术 亚麻醉剂量 神经病理性疼痛 

分 类 号：R614[医药卫生—麻醉学]