艾司氯胺酮复合舒芬太尼PCIA对肝肿瘤切除术后镇静镇痛效果及呼吸循环功能的影响  

Effects of esketamine combined with sufentanil for patient-controlled intravenous analgesia on sedation and analgesia and respiratory and circulatory function after liver tumor resection

作　　者：雷鹤寿 李思盈 罗丹 陈小云 LEI He-shou;LI Si-ying;LUO Dan;CHEN Xiao-yun(Department of Anesthesiology,Wuming Hospital Affiliated to Guangxi Medical University,Nanning 530199,Guangxi,CHINA)

机构地区：[1]广西医科大学附属武鸣医院麻醉科,广西南宁530199

出　　处：《海南医学》2023年第2期202-205,共4页Hainan Medical Journal

基　　金：广西壮族自治区卫生健康委员会自筹经费科研项目(编号:Z20210428)。

摘　　要：目的探讨艾司氯胺酮复合舒芬太尼静脉自控镇痛(PCIA)对肝肿瘤切除术后镇静镇痛效果及呼吸循环功能的影响。方法选择2021年1月至2021年10月于广西医科大学附属武鸣医院实施肝肿瘤切除术的60例原发性肝癌患者为研究对象,依据随机数表法分为舒芬太尼复合艾斯氯胺酮组与舒芬太尼组,每组30例。舒芬太尼组患者使用舒芬太尼+昂丹司琼PCIA镇痛,舒芬太尼复合艾斯氯胺酮组患者在舒芬太尼组的基础上加用艾司氯胺酮。比较两组患者术前4 h及术后24 h、72 h、7 d疼痛强度量表(NRS)评分、平均动脉压(MAP)、血氧饱和度(SaO_(2))、术后3 d、6周抑郁自评量表(SDS)评分及不良反应发生情况。结果术后24 h、72 h、7 d,舒芬太尼复合艾斯氯胺酮组患者的NRS评分分别为(3.57±1.06)分、(2.65±0.63)分、(2.04±0.56)分,明显低于舒芬太尼组的(5.79±1.38)分、(4.18±0.74)分、(3.42±0.76)分,差异均有统计学意义(P<0.05);术后24 h、72 h及7 d,舒芬太尼复合艾斯氯胺酮组患者的MAP分别为(102.24±11.53)mmHg、(91.33±9.27)mmHg、(83.72±5.31)mmHg,明显低于舒芬太尼组的(109.23±12.16)mmHg、(109.23±12.16)mmHg、(92.26±3.26)mmHg,差异均有统计学意义(P<0.05);术后24 h、72 h、7 d,舒芬太尼复合艾斯氯胺酮组患者的SaO_(2)分别为(97.25±2.15)%、(96.76±2.08)%、(97.05±2.03)%,明显高于舒芬太尼组的(94.38±3.06)%、(92.83±2.74)%、(95.25±3.14)%,差异均有统计学意义(P<0.05);术后3 d、6周,舒芬太尼复合艾斯氯胺酮组患者的SDS评分分别为(52.27±11.36)分、(31.15±8.25)分,明显低于舒芬太尼组的(64.26±13.48)分、(51.36±10.94)分,差异均有统计学意义(P<0.05);舒芬太尼复合艾斯氯胺酮组患者的总不良反应发生率为16.67%,略低于舒芬太尼组的20.00%,但差异无统计学意义(P>0.05)。结论肝肿瘤切除术后应用艾司氯胺酮复合舒芬太尼PCIA的镇静镇痛效果良好,且能够明显改善患者的呼吸循环Objective To investigate the effect of esketamine combined with sufentanil for patient-controlled intravenous analgesia(PCIA)on sedation and analgesia and respiratory and circulatory function after liver tumor resection.Methods A total of 60 patients with primary liver cancer who underwent liver tumor resection in Wuming Hospital Affiliated to Guangxi Medical University from January 2021 to October 2021 were selected as the research subjects.According to the random number table method,they were divided into sufentanil combined with esketamine group and sufentanil group,with 30 patients in each group.Sufentanil group was given sufentanil+ondansetron for PCIA,and sufentanil combined with esketamine group was given esketamine on the basis of treatment in sufentanil group.The pain intensity scale(NRS)scores,mean arterial pressure(MAP),blood oxygen saturation(SaO_(2))at 4 h before operation and 24 h,72 h,7 d after operation,depression self-rating scale(SDS)score at 3 days and 6 weeks after surgery,and incidence of adverse reactions were compared between the two groups.Results 24 h,72 h,7 d after operation,the NRS scores of the sufentanil combined with esketamine group were(3.57±1.06)points,(2.65±0.63)points,and(2.04±0.56)points,which were significantly lower than(5.79±1.38)points,(4.18±0.74)points,(3.42±0.76)points of the sufentanil group(P<0.05).At 24 h,72 h and 7 d after operation,the MAP of the patients in sufentanil combined with esketamine group were(102.24±11.53)mmHg,(91.33±9.27)mmHg,and(83.72±5.31)mmHg,which were significantly lower than(109.23±12.16)mmHg,(109.23±12.16)mmHg,(92.26±3.26)mmHg in the sufentanil group(P<0.05).At 24 h,72 h,7 d after the operation,the SaO_(2) of sufentanil combined with esketamine group were(97.25±2.15)%,(96.76±2.08)%,(97.05±2.03)%,which were significantly higher than(90.38±3.06)%,(86.83±2.74)%,(95.25±3.14)%of the sufentanil group(P<0.05).At 3 days and 6 weeks after operation,the SDS scores of sufentanil combined with esketamine group were(52.27±11.36)points and(31

关 键 词：原发性肝癌 肝肿瘤切除术 艾司氯胺酮 静脉自控镇痛 镇静镇痛 呼吸循环功能 

分 类 号：R735.7[医药卫生—肿瘤]