艾司氯胺酮复合右美托咪定行无阿片麻醉对乳腺癌改良根治术患者术后恢复质量的影响  

Effects of opioid-free anesthesia with combined use of esketamine and dexmedetomidine on postoperative recovery quality of patients undergoing modified radical mastectomy

作　　者：刘梦菲 何龙[1] 田丹丹[1] 张迪[1] 许颖 秦菲菲 艾艳秋[1] LIU Mengfei;HE Long;TIAN Dandan;ZHANG Di;XU Ying;QIN Feifei;AI Yanqiu(Department of Anesthesiology and Perioperative Medicine,the First Affiliated Hospital,Zhengzhou University,Zhengzhou 450052)

机构地区：[1]郑州大学第一附属医院麻醉与围术期医学部,郑州450052

出　　处：《郑州大学学报（医学版）》2023年第3期363-366,共4页Journal of Zhengzhou University(Medical Sciences)

基　　金：国家自然科学基金青年基金项目(82001189);河南省科技攻关计划(省部共建)项目(201911225)。

摘　　要：目的:探讨艾司氯胺酮复合右美托咪定行无阿片麻醉对乳腺癌改良根治术患者术后恢复质量的影响。方法:选择2022年2月至6月择期行乳腺癌改良根治术的女性患者82例,年龄18~65岁,其中采用无阿片类药物麻醉40例(OF组),阿片类药物麻醉42例(C组)。OF组麻醉诱导前10 min输注右美托咪定0.6μg/kg,诱导时静脉注射艾司氯胺酮0.5 mg/kg,术中持续泵注右美托咪定0.3μg/(kg·h)和艾司氯胺酮0.25 mg/(kg·h)维持麻醉;C组麻醉诱导前10 min输注等体积的生理盐水,诱导时静脉注射阿芬太尼25~50μg/kg,术中持续泵注瑞芬太尼0.10~0.25μg/(kg·min)维持麻醉。两组患者均复合吸入七氟醚0.8~1.5个肺泡最小有效浓度,间断追加顺式阿曲库铵2~4 mg维持适宜肌松。采用15项恢复质量评分量表(QoR-15)评估患者术前1 d和术后1 d的状态。记录手术时间、拔管时间和麻醉恢复室(PACU)停留时间,术后2、6、12、24 h的数字化疼痛量表(NRS)评分和术后24 h氢吗啡酮消耗量,围术期不良反应(心动过缓、恶心呕吐、头晕、口腔分泌物增多和呼吸抑制)发生情况。结果:与C组比较,OF组术后1 d QoR-15评分下降幅度更小,拔管时间和PACU停留时间延长,术后24 h氢吗啡酮消耗量减少,术后恶心呕吐发生率降低(P<0.05)。两组患者手术时间、术后各时点NRS评分和其他围术期不良反应发生率差异无统计学意义(P>0.05)。结论:艾司氯胺酮复合右美托咪定行无阿片麻醉能够改善乳腺癌改良根治术患者术后恢复质量,减少术后阿片类药物消耗量及术后恶心呕吐的发生率。Aim:To explore the effects of opioid-free anesthesia with combined use of esketamine and dexmedetomidine on postoperative recovery quality of patients undergoing modified radical mastectomy.Methods:Eighty-two female patients undergoing elective modified radical mastectomy from February 2022 to June 2022,aged 18-65 years,were enrolled and allocated into 2 groups,opioid-free anesthesia group(group OF,n=40)and opioid anesthesia group(group C,n=42).Patients in group OF received continuous infusion of dexmedetomidine(0.6μg/kg)over 10 min before induction of anesthesia,and esketamine was induced at 0.5 mg/kg.Dexmedetomidine and esketamine were infused respectively at a rate of 0.3μg/(kg·h)and 0.25 mg/(kg·h).Patients in group C received the equal volume of normal saline over 10 min before induction of anesthesia,and alfentanil was induced at 25-50μg/kg,then remifentanil was infused at a rate of 0.10-0.25μg/(kg·min).For maintenance of anaesthesia,all patients received sevoflurane(minimus alveolar concentration of 0.8-1.5),and discontinuous injection of 2-4 mg cisatracurium.The early postoperative recovery was assessed by Quality of Recovery-15(QoR-15)at 1 day before and after surgery.Operation time,extubation time and length of stay in PACU,the NRS scores at 2,6,12,and 24 hours and the total consumption of hydromorphone within 24 hours after surgery were recorded.The occurrence of perioperative adverse reactions(bradycardia,nausea and vomiting,dizziness,increased oral secretion and respiratory depression)were recorded.Results:Compared with group C,the descending amplitude of QoR-15 score in OF group was less 1 day after surgery,the extubation time and length of stay in PACU in group OF were longer,the 24 hours postoperative hydromorphone consumption in group OF was less,and the incidence of postoperative nausea and vomiting in group OF was lower(P<0.05).The surgery time,NRS scores at 2,6,12 and 24 hours after surgery and other perioperative adverse reactions had no significant difference between the 2 groups(P>0.0

关 键 词：无阿片麻醉 艾司氯胺酮 右美托咪定 乳腺癌改良根治术 恢复质量 

分 类 号：R614.2[医药卫生—麻醉学]