小剂量艾司氯胺酮对瑞芬太尼诱发患者术后痛觉过敏的影响  

Effect of low-dose esketamine on remifentanil-induced postoperative hyperalgesia

作　　者：任燕伶[1] 邢飞 周莉 张卫[1] Ren Yanling;Xing Fei;Zhou Li;Zhang Wei(Department of Anesthesiology and Perioperative Medicine,The First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China)

机构地区：[1]郑州大学第一附属医院麻醉科,郑州450052

出　　处：《中华麻醉学杂志》2023年第1期51-55,共5页Chinese Journal of Anesthesiology

摘　　要：目的评价小剂量艾司氯胺酮对瑞芬太尼诱发患者术后痛觉过敏的影响。方法择期全身麻醉下行甲状腺切除术患者96例,年龄18~60岁,ASA分级Ⅰ或Ⅱ级,BMI 18~30 kg/m^(2),采用随机数字表法分为3组(n=32):对照组(C组)、麻醉诱导前给予艾司氯胺酮组(K1组)和手术结束即刻给予艾司氯胺酮组(K2组)。麻醉诱导前5 min,K1组静脉注射艾司氯胺酮0.4 mg/kg,C组和K2组静脉注射等容量生理盐水。静脉注射异丙酚、瑞芬太尼和罗库溴铵行麻醉诱导;静脉泵注瑞芬太尼0.3μg·kg^(-1)·min^(-1),吸入1.5%~2.5%七氟烷行麻醉维持。手术结束即刻K2组静脉注射艾司氯胺酮0.4 mg/kg,C组和K1组静脉注射等容量生理盐水。分别于术前1 d和术后30 min、6、24、48 h时测量手术切口周围和非优势手前臂的机械痛阈。分别于术后30 min、6、24和48 h时行疼痛数字评分法(NRS)评分,NRS评分≥4分或者患者需要镇痛时,静脉注射氟比洛酚酯补救镇痛。记录术中瑞芬太尼用量、血管活性药物使用情况、苏醒时间、气管拔管时间、PACU停留时间、术后补救镇痛情况和不良反应发生情况。结果与C组比较,K1组和K2组术后30 min和6 h时手术切口周围和非优势手前臂机械痛阈升高(P<0.05);K1组和K2组各时点手术切口周围和非优势手前臂的机械痛阈比较差异无统计学意义(P>0.05)。与C组和K1组比较,K2组苏醒时间、气管拔管时间及PACU停留时间延长,幻觉和腺体分泌物增多发生率升高(P<0.05)。3组术中瑞芬太尼用量、术中阿托品和麻黄碱使用率、术后各时点NRS评分、术后恶心呕吐发生率和补救镇痛率比较差异无统计学意义(P>0.05)。结论麻醉诱导前和手术结束即刻静脉注射小剂量艾司氯胺酮(0.4 mg/kg)可减轻瑞芬太尼诱发患者术后痛觉过敏,且麻醉诱导前给药效果更佳。Objective To evaluate the effects of low-dose esketamine on remifentanil-induced postoperative hyperalgesia in the patients.Methods Ninety-six American Society of Anesthesiologist Physical Status classificationⅠorⅡpatients,aged 18-60 yr,with body mass index of 18-30 kg/m2,scheduled for elective thyroidectomy under general anesthesia,were divided into 3 groups(n=32 each)using a random number table method:control group(group C),esketamine administered before anesthesia induction group(group K1),and esketamine administered immediately after the end of surgery group(group K2).Esketamine 0.4 mg/kg was intravenously injected in group K1,and the equal volume of normal saline was given instead in C and K2 groups at 5 min before anesthesia induction.Anesthesia was induced by intravenous injection of propofol,remifentanil and rocuronium.Remifentanil was intravenously infused at a rate of 0.3μg·kg^(-1)·min^(-1)and 1.5%-2.5%sevoflurane was inhaled for anesthesia maintenance.Esketamine 0.4 mg/kg was intravenously injected in group K2 and the equal volume of normal saline was given instead in C and K1 groups immediately after the end of surgery.The mechanical pain thresholds of surgical incision and forearm of non-dominant hand were measured at 1 day before surgery and 30 min,6 h,24 h and 48 h after surgery,and flurbiprofen axetil was intravenously injected for rescue analgesia when the NRS score≥4 or the patient needed sedation.The intensity of pain was estimated using numeric rating scale at 30 min,6 h,24 h and 48 h after surgery.The intraoperative consumption of remifentanil,use of vasoactive drugs,recovery time,tracheal extubation time,duration of PACU stay,postoperative rescue analgesia and adverse reactions were recorded.Results Compared with C group,the mechanical pain threshold around surgical incision and of the forearm of non-dominant hand was significantly increased at 30 min and 6 h after surgery in K1 and K2 groups(P<0.05).Compared with C and K1 groups,the emergence time,tracheal extubation time,and durat

关 键 词：氯胺酮 瑞芬太尼 痛觉过敏 疼痛 手术后 

分 类 号：R614[医药卫生—麻醉学]