不同剂量艾司氯胺酮复合右美托咪定在食管癌术后自控静脉镇痛患者中的应用效果对比  

Comparison of the Efficacy of Different Doses of Esketamine Combined with Dexmedetomidine in Patients with Postoperative Patient-controlled Intravenous Analgesia for Esophageal Cancer

作　　者：程丽莎 王照飞[1] 徐韡韡[1] 陈花如 CHENG Lisa;WANG Zhaofei;XU Weiwei(The First Affiliated Hospital of Zhengzhou University,Zhengzhou,450000)

机构地区：[1]郑州大学第一附属医院,450000 [2]河南省阜外华中心血管病医院,450000

出　　处：《实用癌症杂志》2024年第7期1155-1158,1166,共5页The Practical Journal of Cancer

摘　　要：目的 分析不同剂量艾司氯胺酮复合右美托咪定在食管癌术后自控静脉镇痛(PCIA)中的应用效果。方法 选取87例食管癌患者,按随机数字表法分为常规组、对照组与观察组,各29例。所有患者均行食管癌根治术,术后均运用PCIA,常规组镇痛液配方为100μg右美托咪定+2μg/kg舒芬太尼+0.25 mg帕洛诺+氯化钠注射液100 ml,对照组则在常规组基础上加以0.03 mg/(kg·h)艾司氯胺酮,观察组则在常规组基础上加以0.015 mg/(kg·h)艾司氯胺酮。对比3组镇痛效果、炎性因子水平、应激反应、抑郁症状、不良反应。结果 术后12 h、24 h,对照组的VAS评分低于观察组与常规组,差异有统计学意义(P<0.05)。术前,3组C反应蛋白(CRP)、白介素-6(IL-6)、降钙素原(PCT)、去甲肾上腺素(NE)、皮质醇(Cor)相比,差异无统计学意义(P>0.05);术后24 h、术毕时,对照组CRP、IL-6、PCT、NE、Cor低于观察组与常规组,差异有统计学意义(P<0.05)。术前,3组抑郁自评量表(SDS)评分相比,差异无统计学意义(P>0.05);术后1周,观察组SDS评分低于对照组与常规组,差异有统计学意义(P<0.05)。3组不良反应相当,差异无统计学意义(P>0.05)。结论 大剂量的艾司氯胺酮复合右美托咪定用于食管癌术后PCIA可取得更强的镇痛效果,能够更有效地控制机体的炎症反应与应激反应,但小剂量的艾司氯胺酮不良反应更少,且抗抑郁效果更强。Objective To analyze the efficacy of different doses of Esketamine combined with dexmedetomidine in patient controlled intravenous analgesia(PCIA)after esophageal cancer surgery.Methods 87 patients with esophageal cancer were selected and randomly divided into the control group,and the observation group using a random number table method,with 29 cases in each group.All patients underwent esophageal cancer radical surgery,and PCIA was used postoperatively.The formula of the conventional group analgesic solution was 100μG dexmedetomidine+2μG/kg sufentanil+0.25 mg palonol+100 ml sodium chloride injection.The control group received 0.03 mg/(kg·h)ketamine in addition to the conventional group,while the observation group received 0.015 mg/(kg·h)ketamine in addition to the conventional group.Compared the analgesic effects,levels of inflammatory factors,stress reactions,depressive symptoms,and adverse reactions among three groups.Results At 12h,and 24h after surgery,the VAS score of the control group was significantly lower than that of the observation group and the conventional group(P<0.05);Before surgery,there was no statistically significant difference in C-reactive protein(CRP),interleukin-6(IL-6),procalcitonin(PCT),norepinephrine(NE),and cortisol(Cor)among the three groups(P>0.05);24 hours after surgery and at the end of the surgery,the CRP,IL-6,PCT,NE,and Cor in the control group were lower than those in the observation group and the control group,and the difference was statistically significant(P<0.05).Before surgery,there was no statistically significant difference in SDS scores among the three groups(P>0.05);One week after surgery,SDS score of the observation group was significantly lower than that of the control group and the conventional group(P<0.05);The adverse reactions in the 3 groups were similar,with no statistically significant difference(P>0.05).Conclusion High dose of Esketamine combined with dexmedetomidine can achieve a stronger analgesic effect in PCIA after esophageal cancer surgery,and can m

关 键 词：食管癌 自控静脉镇痛 艾司氯胺酮 右美托咪定 不良反应 

分 类 号：R735.1[医药卫生—肿瘤]