小剂量艾司氯胺酮对不同靶浓度瑞芬太尼术后痛觉敏化的预防效应  

Prevention effects of low-dose esketamine plus different remifentanil target concentrations on the postoperative pain sensitization

作　　者：王嘉炜 纪宏新[1] 黄静[1] 高军 WANG Jia-wei;JI Hong-xin;HUANG Jing(Department of Anesthesiology,The People's Hospital of Longgang District,Shenzhen City the Second Affiliated Hospital of the Chinese University of Hong Kong(Shenzhen),Shenzhen 518172,China)

机构地区：[1]深圳市龙岗区人民医院香港中文大学(深圳)附属第二医院麻醉科,广东深圳518172

出　　处：《吉林医学》2023年第10期2835-2839,共5页Jilin Medical Journal

基　　金：深圳市龙岗区科技创新发展项目[项目编号:LGKCYLWS2020001052]。

摘　　要：目的:探究小剂量艾司氯胺酮对不同靶浓度瑞芬太尼术后痛觉敏化的预防效应。方法:以随机抽样法为分组依据,将2020年1月~2021年1月120例全身麻醉择期手术患者分为研究1组(诱导及维持瑞芬太尼靶浓度2 ng/ml)、研究2组(靶浓度4 ng/ml)、研究3组(靶浓度6 ng/ml)各40例,所有患者麻醉诱导前30 min静脉注射0.25 mg/kg艾司氯胺酮,对干预效果进行分析比较。结果:研究3组在麻醉药效持续时间、麻醉后睁眼反射恢复时间、术后拔管时间均显著短于研究1组、研究2组,差异有统计学意义(P<0.05),T_(2)表示切皮即刻,T_(4)表示缝皮,T_(5)表示手术结束时研究2组的麻醉深度监测(BIS)值显著高于研究1组、研究2组,差异有统计学意义(P<0.05),T_(1)、T_(4)表示缝皮时研究1组的心律(HR)显著高于研究2组、研究3组,差异有统计学意义(P<0.05),T_(1)表示插管即刻、T_(3)表示手术开始30 min、T_(4)表示缝皮时研究1组的平均动脉压(MAP)显著高于研究2组、研究3组,差异有统计学意义(P<0.05),拔管时研究对象的视觉模拟评分(VRS)对比差异无统计学意义(P>0.05),拔管15 min、拔管半小时后研究1组、研究2组VRS评分均低于研究3组,差异有统计学意义(P<0.05),且研究1组与研究2组之间差异无统计学意义(P>0.05),拔管2 h、4 h及8 h后研究1组、研究2组VAS评分均低于研究3组,差异有统计学意义(P<0.05),且研究1组与研究2组之间差异无统计学意义(P>0.05)。结论:小剂量艾司氯胺酮对瑞芬太尼术后痛觉敏化具有一定的预防效应,但随着瑞芬太尼浓度的提升,预防效应呈下降趋势。Objective To explore the prevention effects of low-dose esketamine plus different remifentanil target concentrations on the postoperative pain sensitization.Method According to random sampling method,120 patients of undergoing the selective operation under the general anesthesia from January 2020 to January 2021 were divided into study group 1(anesthesia induction and 2 ng/ml of remifentanil target concentrations),study group 2(4 ng/ml of target concentrations)and study group 3(6 ng/ml of target concentrations),40 cases in each group.Before 30 min of anesthesia induction,all of patients took the intravenous injection of 0.25 mg/kg esketamine.Intervention effects were probed.Results The anesthetic duration,eye reflux recovery time and postoperative extubation time in study group 3 were significantly shorter than study group 1 and study group 2(P<0.05);T_(2) represents immediate skin removal,T_(4) represents suturing,and T_(5) represents the end of the Surgery,BIS(bispectral index)value in study group 2 was significantly higher than study group 1 and study group 3(P<0.05);T_(1) and T_(4) represents suturing,heart rate(HR)in study group 1 was significantly higher than study group 2 and study group 3(P<0.05);T_(1) represents immediate intubation,T_(3) represents the start of surgery for 30 ming,and T_(4) regresents suturing time,mean arterial pressure(MAP)in study group 1 was significantly higher than study group 2 and study group 3(P<0.05);upon extubation,VRS(verbal rating scale)scores among groups were not significantly different(P>0.05);after 15 min and 30 min of extubation,VRS scores in study group 1 and study group 2 were significantly lower than study group 3(P<0.05);but VRS scores between study group 1 and study group 2 were not significantly different(P>0.05);after 2 h,4 h and 8 h of extubation,VAS(visual analogue scale)scores in study group 1 and study group 2 were significantly lower than study group 3(P<0.05);VAS scores between study group 1 and study group 2 were not significantly different(P>0.05).Conclu

关 键 词：瑞芬太尼 艾司氯胺酮 痛觉敏化 麻醉 预防 

分 类 号：R614[医药卫生—麻醉学]