不同剂量艾司氯胺酮联合罗哌卡因前锯肌平面阻滞对胸腔镜手术病人术后镇痛的影响  

Efficacy of serratus anterior plane block with different doses of esketamine combined with ropivacaine in postoperative analgesia for patients undergoing thoracoscopic surgery

作　　者：丁冰 寇清晏 王艳婷[1] 王羽 李琳[1] 牛泽军[1] DING Bing;KOU Qingyan;WANG Yanting;WANG Yu;LI Lin;NIU Zejun(Anesthesiology Department,The Affiliated Hospital of Qingdao University,Qingdao 266000,China)

机构地区：[1]青岛大学附属医院麻醉科,山东青岛266000 [2]青岛大学附属医院肝胆胰外科,山东青岛266000

出　　处：《青岛大学学报（医学版）》2024年第2期279-283,共5页Journal of Qingdao University(Medical Sciences)

基　　金：青岛大学附属医院“临床医学+X”科研项目(QDFY+X202101057)。

摘　　要：目的评价不同剂量艾司氯胺酮联合罗哌卡因前锯肌平面阻滞(SAPB)对胸腔镜手术病人术后镇痛的影响。方法选择择期行胸腔镜手术病人96例,随机分为单纯罗哌卡因组(A组,SAPB局麻药为5 g/L罗哌卡因30 mL)、0.25 mg/kg艾司氯胺酮组(B组,在5 g/L罗哌卡因的基础上加用0.25 mg/kg艾司氯胺酮)、0.50 mg/kg艾司氯胺酮组(C组,在5 g/L罗哌卡因的基础上加用0.50 mg/kg艾司氯胺酮)。记录术后2、6、12、24、48 h时的数字等级评定量表(NRS)评分,术后48 h吗啡用量,术后首次按压静脉自控镇痛(PCIA)装置时间,术后需要PCIA病人比例,术中舒芬太尼的用量及不良反应发生情况。结果与A组相比较,C组术后12、24 h NRS评分均显著降低(H=9.006、8.785,P<0.05),术后48 h吗啡用量减少(H=7.400,P<0.05),首次按压PCIA时间明显延长(P<0.05)。3组需要PCIA病人比例和术中舒芬太尼用量差异无统计学意义(P>0.05)。3组不良反应发生率差异无统计学意义(P>0.05)。结论与单纯应用罗哌卡因相比,0.50 mg/kg艾司氯胺酮联合罗哌卡因SAPB用于胸腔镜手术病人可增强术后镇痛效果,减少术后48 h吗啡用量,延长SAPB镇痛持续时间,且无明显不良反应。Objective To investigate the efficacy of serratus anterior plane block(SAPB)with different doses of esketamine combined with ropivacaine in postoperative analgesia for patients undergoing thoracoscopic surgery.Methods A total of 96 patients who underwent elective thoracoscopic surgery were enrolledand randomly divided into group A(ropivacaine alone,with 30 mL of 5 g/L ropivacaine as the local anesthetic in SAPB),group B(0.25 mg/kg esketamine in addition to 5 g/L ropivacaine),and group C(0.50 mg/kg esketamine in addition to 5 g/L ropivacaine).Numerical Rating Scale(NRS)score was recorded at 2,6,12,24,and 48 hours after surgery,as well as the amount of morphine used at 48 hours after surgery,the time to the first pressing of patient-controlled intravenous analgesia(PCIA)device after surgery,the proportion of patients requiring PCIA after surgery,the amount of sufentanil used during surgery,and the incidence rate of adverse reactions.Results Compared with group A,group C had a significant reductionin NRS score at 12 and 24 hours after surgery(H=9.006,8.785,P<0.05),a significant reduction in the amount of morphine used at 48 hours after surgery(H=7.400,P<0.05),and a significant prolongation of the time to the first pressing of PCIA(P<0.05).There were no significant differences between the three groups in the proportion of patients requiring PCIA and the amount of sufentanil used during surgery(P>0.05).There was also no significant difference in the incidence rate of adverse reactions between the three groups(P>0.05).ConclusionCompared with ropivacaine alone,the combination of 0.50 mg/kg esketamine and ropivacaine for SAPB in patients undergoing thoracoscopic surgery can enhance the postoperative analgesic effect,reduce the amount of morphine used at 48 hours after surgery,and prolong the duration of SAPB analgesia,with little adverse effect.

关 键 词：氯胺酮 罗哌卡因 神经肌肉阻滞 胸外科手术 电视辅助 疼痛 手术后 

分 类 号：R971.2[医药卫生—药品] R614.4[医药卫生—药学]