艾司氯胺酮复合舒芬太尼自控静脉镇痛对胸腔镜患者术后睡眠质量的影响  

Effect of patient-controlled intravenous analgesia with Esketamine combined with sufentanil on postoperative sleep quality in patients undergoing thoracoscopic surgery

作　　者：贾伟毅 雷少青[1] JIA Weiyi;LEI Shaoqing(Dept.of Anesthesiology,Renmin Hospital of Wuhan University,Wuhan 430060,Hubei,China)

机构地区：[1]武汉大学人民医院麻醉科,湖北武汉430060

出　　处：《武汉大学学报（医学版）》2024年第7期862-867,共6页Medical Journal of Wuhan University

摘　　要：目的:评价艾司氯胺酮复合舒芬太尼自控静脉镇痛(PCIA)对胸腔镜患者术后睡眠质量的影响。方法:选择2022年5至7月武汉大学人民医院行胸腔镜肺部手术患者96例,采用随机数字表法将其分为舒芬太尼组(A组)和艾司氯胺酮与舒芬太尼联合组(B组),每组48例。两组采用常规静脉麻醉诱导和静脉+吸入复合麻醉维持。手术结束前5 min两组均使用0.375%罗哌卡因15~20 mL行肋间神经阻滞。手术结束后分别配置静脉镇痛泵,其中A组PCIA:舒芬太尼2μg/kg+昂丹司琼4 mg;B组PCIA:舒芬太尼1.5μg/kg+艾司氯胺酮1 mg/kg+昂丹司琼4 mg。评估患者术前、术后第1天、术后第2天匹茨堡睡眠质量指数量表(PSQI);观察并记录术后0,4,8,24,48 h的视觉模拟疼痛评分(VAS评分)、血压、心率以及不良反应。结果:(1)睡眠质量:两组患者术前的PSQI得分比较,差异无统计学意义(P>0.05);术后第1天、术后第2天的PSQI得分,艾司氯胺酮与舒芬太尼联合组(B组)明显低于舒芬太尼组(A组),差异均有统计学意义(P<0.05);(2)镇痛效果:术后T0(0 h)、术后T1(4 h)、术后T2(8 h)比较,两组患者的VAS评分比较差异无统计学意义(P>0.05);术后T3(24 h)、术后T4(48 h)比较,B组VAS评分明显低于A组,差异均有统计学意义(P<0.05);(3)不良反应发生率:两组患者术后0,4,8,24,48 h的低血压、心动过缓、头晕、恶心、呕吐、嗜睡、皮肤瘙痒、呼吸抑制的情况比较,差异无统计学意义。结论:艾司氯胺酮复合舒芬太尼自控静脉镇痛对胸腔镜术后患者来说,可以改善术后睡眠质量。Objective:To evaluate the effect of patient-controlled intravenous analgesia(PCIA)with ketamine and sufentanil on sleep quality in patients after thoracoscopic surgery.Methods:A total of 96 patients who underwent thoracoscopic lung surgery at Renmin Hospital of Wuhan University from May to July 2022 were selected and randomly divided into the sufentanil group(Group A)and combination group(Group B)using a random number table method,with 48 patients in each group.Both groups were treated with conventional intravenous anesthesia induction and intravenous inhalation combined maintenance.Both groups were treated with 0.375%ropivacaine 15-20 mL for intercostal nerve block 5 minutes before the end of the surgery.After the surgery,intravenous analgesia pumps were allocated,with PCIA of Group A consisting of sufentanil 2μg/kg and ondansetron 4 mg,and PCIA of Group B consisting of sufentanil 1.5μg/kg+eszketamine 1 mg/kg+ondansetron 4 mg.The Pittsburgh Sleep Quality Index(PSQI)was adopted to evaluate the sleep quality of patients before surgery,on the first day and the second day after surgery.The visual analog pain score(VAS score),blood pressure,heart rate,and adverse reactions were recorded at 0,4,8,24,and 48 hours after surgery.Results:(1)Sleep quality:There was no statistically significant difference in preoperative PSQI scores between the two groups of patients(P>0.05);The PSQI scores on the first and second postoperative days were significantly lower in the combination group of Esketamine and sufentanil(Group B)than in the sufentanil group(Group A)(P<0.05);(2)Analgesic effect:There was no statistically significant difference in VAS scores between the two groups of patients at T0(0 h),T1(4 h),and T2(8 h)after surgery(P>0.05);At the timepoints of T3(24 h)and T4(48 h)after surgery,the VAS scores of Group B were significantly lower than that of Group A(P<0.05);(3)Adverse reactions:There was no significant difference in hypotension,bradycardia,dizziness,nausea,vomiting,drowsiness,skin itching,and respiratory depression

关 键 词：艾司氯胺酮 舒芬太尼 自控静脉镇痛 术后睡眠质量 

分 类 号：R614[医药卫生—麻醉学]