艾司氯胺酮联合罗哌卡因舒芬太尼对下肢骨折手术患者术后硬膜外自控镇痛应用研究  

Study on the Application of Esketamine Combined with Ropivacaine Sufentanil in Postoperative Patient-Controlled Epidural Analgesia for Patients with Lower Limb Fractures

作　　者：谢长春 钟年青 王建平 王香莲 付林芳 钟勇 Xie Changchun(People’s Hospital of Ganxian District,Ganzhou City,Ganzhou Jiangxi 341000)

机构地区：[1]赣州市赣县区人民医院麻醉科,江西赣州341100

出　　处：《黑龙江医药》2024年第5期1043-1046,共4页Heilongjiang Medicine journal

基　　金：赣州市科技计划项目(编号:20222ZDX9891)。

摘　　要：目的:分析艾司氯胺酮联合罗哌卡因舒芬太尼对下肢骨折手术患者术后硬膜外自控镇痛的临床效果。方法:选取2022年3月至2023年2月于赣县区人民医院行下肢骨折手术患者60例作为研究对象,根据随机数字法分为两组。术后行连续硬膜外自控镇痛(Patient Controlled Epidural Analgesia,PCEA),对照组(30例)给予0.15%罗哌卡因+1μg/mL舒芬太尼+生理盐水(NS)总量至100mL,观察组(30例)给予0.15%罗哌卡因+0.5μg/mL舒芬太尼+0.5mg/mL艾司氯胺酮+NS总量至100mL。对两组术后不同时间点疼痛程度、运动阻滞情况、镇静评分、自控镇痛次数及不良反应进行比较。结果:术后6h、12h、24h及48h,观察组VAS评分均低于对照组;术后48h内自控镇痛次数少于对照组;术后6h,观察组Bromage评分高于对照组,有统计学差异(P<0.05)。术后12h、24h及48h,两组Bromage评分比较,无统计学差异(P>0.05);术后6h、12h、24h及48h,两组Ramsay镇静评分比较,无统计学差异(P>0.05)。且相较于对照组,观察组不良反应发生率较低,有统计学差异(P<0.05)。结论:对于下肢骨折手术的患者,0.15%罗哌卡因+0.5μg/mL舒芬太尼+0.5mg/mL艾司氯胺酮+NS总量至100mL效果确切,可有助于减轻患者疼痛,且较为安全。Objective:To analyze the clinical efficacy of combining esketamine with ropivacaine and sufentanil for postoperative epidural controlled analgesia in patients undergoing lower extremity fracture surgery.Methods:60 patients who underwent lower limb fracture surgery in the People’s Hospital of Ganxian District from March 2022 to February 2023 were selected as the research objects,and divided into two groups according to random number method.The control group(30 cases)was given 0.15%ropivacaine+1μg/ mL sufentanil+total amount of saline (NS) to 100mL, and the observation group (30 cases) was given 0.15% ropivacaine+0.5μg/mL sufentanil+0.5mg/mL aceketamine + total amount of NS to 100mLPain scores, motor block, sedation levels, number of analgesic administrations, and adverse reactions were compared at different time points between the two groups.Results: At 6, 12, 24, and 48hours postoperatively, the VAS scores of the observation group were lower than those of the control group;The frequency of self controlled analgesia within 48 hours after surgery was less than that of the control group;At 6 hours postoperatively, the Bromage score in the observation group was higher than that in the control group, with a statistically significant difference( P <0.05). There was no statistically significant difference in Bromage scores between the two groups at 12, 24, and 48 hours after surgery( P >0.05);There was no statistically significant difference in Ramsay sedation scores between the two groups at 6h, 12h, 24h, and 48h after surgery( P > 0.05 ). Compared with the control group, the incidence of adverse reactions in the observation group was lower, with statistical differences( P <0.05).Conclusion: For patients undergoing lower extremity fracture surgery, 0.15% ropivacaine + 0.5μg/mL sufentanil + 0.5mg/mL acephate ketamine + NS total to 100mL is effective and can help to reduce the patient’s pain and is safer.

关 键 词：下肢骨折手术 术后硬膜外自控镇痛 艾司氯胺酮 罗哌卡因 舒芬太尼 

分 类 号：R683.42[医药卫生—骨科学]