艾司氯胺酮用于腰硬联合麻醉下子宫全切术的有效性和安全性  

Efficacy and safety of esketamine for total hysterectomy under combined spinal and epidural anesthesia

作　　者：许德奖[1] 邱泽挺 XU Dejiang;QIU Zeting(Department of Anesthesiology,the First Affiliated Hospital of Shantou University Medical College,Shantou 515041,China)

机构地区：[1]汕头大学医学院第一附属医院麻醉科,广东汕头515041

出　　处：《汕头大学医学院学报》2023年第1期6-10,共5页Journal of Shantou University Medical College

基　　金：广东省医院药学研究基金(2020XC19,2020XC21);汕头市医疗卫生科技计划项目(汕府科〔2021〕3号-75)。

摘　　要：目的:探讨艾司氯胺酮用于腰硬联合麻醉下腹式子宫全切术围手术期疼痛管理的有效性和安全性。方法:选取2020年10月—2022年4月在汕头大学医学院第一附属医院行腰硬联合麻醉下腹式子宫全切术的患者200例,随机分为试验组(接受艾司氯胺酮静脉镇静)和对照组(接受右美托咪定静脉镇静),每组各100例。记录患者一般资料、Ramsay镇静评分、视觉模拟评分法疼痛评分、不良反应和术后镇痛泵使用情况。结果:与对照组相比,试验组患者在手术开始至术后3 h的Ramsay镇静评分更高,术后48 h视觉模拟评分法疼痛评分更低,手术开始至术后3 h内低氧血症、躁动发生率较高,心动过缓、低血压发生率较低(P值均<0.05)。试验组和对照组患者术后48 h镇痛泵的药物用量和按压次数分别为(107.1±7.5)mL、(6.8±1.8)次,对照组分别为(110.6±11.9)mL、(7.8±3.5)次。与对照组相比,试验组的镇痛泵药物用量和按压次数均低于对照组(P值均<0.05)。结论:艾司氯胺酮用于腰硬联合麻醉下腹式子宫全切术的镇静和镇痛效果确切,能有效减轻患者术后48 h内的疼痛,但可能出现低氧血症和躁动。Objective:To investigate the efficacy and safety of esketamine in the perioperative pain management of combined spinal and epidural anesthesia for transabdominal total hysterectomy.Methods:Two hundred patients who underwent transabdominal total hysterectomy under combined spinal and epidural anesthesia in the First Affiliated Hospital of Shantou University Medical College from October 2020 to April 2022 were selected and randomly divided into a test group(received intravenous sedation with esketamine)and a control group(received intravenous sedation with dexmedetomidine),100 patients in each group.The general data,Ramsay sedation score,pain score by visual analogue scale,adverse effects and postoperative analgesic pump use were recorded.Results:Compared with the control group,patients in the test group had higher Ramsay sedation scores from the beginning of surgery to 3 h postoperatively,lower pain scores by visual analogue scale method at 48 h postoperatively,higher incidence of postoperative hypoxemia and agitation,and lower incidence of bradycardia and hypotension.The dosage of pain pump medication and number of compressions at 48 h postoperatively were(107.1±7.5)mL and(6.8±1.8)in the test and control groups,respectively,and(110.6±11.9)mL and(7.8±3.5)in the control group,respectively.Compared with the control group,dosage of pain pump medication and number of compressions were lower in the test group than in the control group(allP values<0.05).Conclusion:Esketamine has definite sedative and analgesic effects in transabdominal total hysterectomy under combined spinal and epidural anesthesia,and can effectively relieve pain within 48 hours after operation,but hypoxemia and restlessness may occur.

关 键 词：艾司氯胺酮 腹式子宫全切术 围手术期疼痛管理 右美托咪定 

分 类 号：R614[医药卫生—麻醉学]