不同剂量艾司氯胺酮联合舒芬太尼在胸腔镜肺楔形切除术后镇痛效果的评价  

Postoperative analgesic effect of esketamine combined with sufentanil in different dose after thoracoscopic pulmonary wedge resection

作　　者：王龙 戚钰 周海[1] 王立伟[1] 徐海军[1] 刘松涛[1] Wang Long;Qi Yu;Zhou Hai;Wang Liwei;Xu Haijun;Liu Songtao(Department of Anesthesiology,Xuzhou Central Hospital,Xuzhou City,Jiangsu Province 221009,China)

机构地区：[1]徐州市中心医院麻醉科,徐州市221009

出　　处：《中华疼痛学杂志》2023年第1期99-104,共6页Chinese Journal Of Painology

基　　金：徐州市科技创新重点研发计划(KC21251);江苏省麻醉重点实验室开放课题(XZSYSKF2021011)。

摘　　要：目的探讨不同剂量艾司氯胺酮联合舒芬太尼在胸腔镜下肺楔形切除术后的镇痛效果。方法收集2021年9月至2022年4月徐州市中心医院胸外科收治的拟行胸腔镜下肺楔形切除术患者120例, 按随机数表法将患者分为3组:胸壁联合肋间神经阻滞+高剂量艾司氯胺酮+舒芬太尼组(H组, n=40), 胸壁联合肋间神经阻滞+低剂量艾司氯胺酮+舒芬太尼组(L组, n=40), 胸壁联合肋间神经阻滞+舒芬太尼组(C组, n=40)。3组均实施全身麻醉, 双腔管气管插管, 麻醉开始前予以0.375%罗哌卡因行胸壁+肋间神经阻滞, 术后采用PCIA镇痛。H组PCIA药物配方为艾司氯胺酮0.02 mg·kg^(-1)·h^(-1)+舒芬太尼0.03 μg·kg^(-1)·h^(-1)+托烷司琼10 mg;L组PCIA药物配方为艾司氯胺酮0.01 mg·kg^(-1)·h^(-1)+舒芬太尼0.03 μg·kg^(-1)·h^(-1)+托烷司琼10 mg;C组PCIA药物配方为舒芬太尼0.03 μg·kg^(-1)·h^(-1)+托烷司琼10 mg。记录患者术后4、12、24、48和72 h的视觉模拟评分(VAS);记录术后48 h内镇痛泵有效按压次数及补救镇痛的人数;记录患者术后心律失常、头晕恶心、尿潴留和呼吸抑制等不良反应。结果 H组术后4、12、24、48及72 h的VAS评分较L组和C组的评分均降低(P均<0.05), L组与C组在各时点的VAS评分差异均无统计学意义(P>0.05)。与各组术后4 h的VAS评分比较, H组、L组和C组患者术后12 h的VAS评分升高(P<0.05), 72 h的VAS评分降低(P<0.05)。3组术后镇痛泵有效按压次数、补救镇痛率和不良反应发生率的比较, 差异无统计学意义(P>0.05)。结论高剂量艾司氯胺酮复合舒芬太尼、低剂量艾司氯胺酮复合舒芬太尼和无艾司氯胺酮组3种镇痛方式均可安全有效应用于胸腔镜下肺楔形切除患者的术后镇痛, 高剂量艾司氯胺酮术后镇痛效果明显优于低剂量艾司氯胺酮及无艾司氯胺酮组。Objective To investigate the analgesic effect of different doses of esketamine combined with sufentanil after thoracoscopic wedge pneumonectomy.Methods From September 2021 to April 2022,one hundred and twenty patients undergoing thoracoscopic wedge pneumonectomy in the Thoracic Surgery Department of Xuzhou Central Hospital were randomly divided into three groups:chest wall combined with intercostal nerve block+high-dose esketamine+sufentanil group(group H,n=40),chest wall combined with intercostal nerve block+low-dose esmolamine+sufentanil group(group L,n=40)and chest wall combined with intercostal nerve block+sufentanil group(group C,n=40).All the patients were given general anesthesia,double-lumen tracheal intubation,chest wall and intercostal nerve block with 0.375%ropivacaine before anesthesia,and postoperative analgesia with PCIA in the three groups.The PCIA drug formula was:esketamine 0.02 mg·kg^(-1)·h^(-1)+sufentanil 0.03μg·kg^(-1)·h^(-1)+tropisetron 10 mg in the group H,esketamine 0.01 mg·kg^(-1)·h^(-1)+sufentanil 0.03μg·kg^(-1)·h^(-1)+tropisetron 10 mg in the group L,sufentanil 0.03μg·kg^(-1)·h^(-1)+tropisetron 10 mg in the group C.The visual analogue scale(VAS)was recorded at 4,12,24,48 and 72 hours after the operation,the effective pressing times of analgesia pump and the number of patients with rescue analgesia within 48 hours after operation were recorded,and the adverse reactions such as arrhythmia,dizziness,nausea,urinary retention and respiratory depression were recorded.Results The VAS scores were lower at 4,12,24,48 and 72 hours after the operation in the group H than those in the group L and those in the group C.There was no significant difference in VAS scores between the group L and the group C at each time point(P>0.05).Compared with the VAS scores at 4 hours after surgery,the VAS scores increased at 12 hours after the surgery in the group H,L and C and the VAS scores at 24 hours after surgery(P<0.05),and the VAS scores decreased at 72 hours after surgery(P<0.05).There was no si

关 键 词：艾司氯胺酮 胸腔镜 肺楔形切除术 神经传导阻滞 疼痛 手术后 镇痛 病人控制 

分 类 号：R614[医药卫生—麻醉学]