艾司氯胺酮与舒芬太尼对肝硬化并发肝癌病人微波消融术麻醉效果比较  

Comparison of the anesthetic effects of esketamine and sufentanil in patients with liver cirrhosis and liver cancer undergoing microwave ablation

作　　者：李丽[1] 曹菀青 刘文宗 唐国强[3] 王旭 张贤亮[1] LI Li;CAO Wanqing;LIU Wenzong;TANG Guoqiang;WANG Xu;ZHANG Xianliang(Department of Anesthesiology,Shijiazhuang Fifth Hospital,Shijiazhuang 050024,China)

机构地区：[1]石家庄市第五医院麻醉科,河北石家庄050024 [2]石家庄市第五医院外科,河北石家庄050024 [3]石家庄市第五医院手术室,河北石家庄050024

出　　处：《青岛大学学报(医学版)》2025年第1期120-124,共5页Journal of Qingdao University(Medical Sciences)

基　　金：河北省医学科学研究课题计划项目(20241846)。

摘　　要：目的比较艾司氯胺酮与舒芬太尼对肝硬化并发肝癌病人微波消融术麻醉效果。方法2022年3月—2023年11月,在石家庄市第五医院确诊并行经皮微波消融术治疗的肝硬化并发肝癌病人70例,采用简单随机分组方法分为观察组和对照组,每组35例。对照组给予舒芬太尼+丙泊酚麻醉,观察组给予艾司氯胺酮+丙泊酚麻醉,比较两组清醒时间、呼吸恢复时间、拔管时间和不良反应,以及入手术室后5 min(T0)、麻醉开始时(T1)、手术开始5 min(T2)和手术结束时(T3)各时点的疼痛强度量表(NRS)评分、收缩压(SBP)和心率(HR)指标。结果观察组病人的清醒、呼吸恢复及拔管时间与对照组比较均明显延长(t=2.453~8.326,P<0.05)。与术前比较,术后6、12和24 h两组病人NRS评分均明显升高(F=17.033、34.159,P<0.001),但观察组NRS评分均低于对照组(F=8.658~13.682,P<0.05)。在T1、T2和T3时,对照组SBP和HR均显著高于观察组(F=3.986、4.563,P<0.05);与T0时比较,观察组病人在T1、T2和T3时的SBP与HR均无明显变化(P>0.05),而对照组病人各时点的SBP和HR均明显升高(F=5.523~12.799,P<0.05)。观察组不良反应发生率(8.6%)虽然低于对照组(17.1%),但两组比较差异无统计学意义(χ^(2)=1.148,P>0.05)。结论相比舒芬太尼应用于肝硬化并发肝癌病人微波消融术麻醉,艾司氯胺酮不仅能更有效降低术后疼痛程度,还能更有效维持病人血流动力学参数稳定,且具有较好的安全性。Objective To compare the anesthetic effects of esketamine and sufentanil in patients with liver cirrhosis and liver cancer undergoing microwave ablation.Methods Seventy patients with liver cirrhosis and liver cancer,diagnosed and treated by percutaneous microwave ablation in Shijiazhuang Fifth Hospital from March 2022 to November 2023,were enrolled in the study and randomized into observation group and control group,with 35 cases in each group.The control group received sufentanil plus propofol,while the observation group received esketamine plus propofol.The two groups were compared for differences in time to awakening,respiratory recovery time,extubation time,adverse reactions,and numerical rating scale(NRS)scores for pain,systolic blood pressure(SBP),and heart rate(HR)at 5 min after entry(T0),at the beginning of anesthesia(T1),at 5 min of surgery(T2),and at the end of surgery(T3).Results Time to awakening,respiratory recovery time,and extubation time in the observation group were significantly longer than those in the control group(t=2.453-8.326,P<0.05).Compared with preoperative results,NRS scores at 6,12,and 24 h after operation were significantly higher in both groups(F=17.033,34.159,P<0.001),but NRS scores in the observation group were significantly lower than those in the control group(F=8.658-13.682,P<0.05).At T1,T2 and T3,SBP and HR in the control group were significantly higher than those in the observation group(F=3.986,4.563,P<0.05).The observation group had no significant changes in SBP and HR at T1,T2,and T3 compared with those at T0(P>0.05),while the control group had significantly increased SBP and HR at all time points(F=5.523-12.799,P<0.05).The incidence of adverse reactions in the observation group(8.6%)was lower than that in the control group(17.1%),but there was no significant difference between the two groups(χ^(2)=1.148,P>0.05).Conclusion Compared with sufentanil,esketamine is more effective in reducing postoperative pain and maintaining stable hemodynamic parameters in patients with live

关 键 词：氯胺酮 舒芬太尼 癌 肝细胞 肝硬化 导管消融术 微波 镇痛 治疗结果 

分 类 号：R971.2[医药卫生—药品] R730.261[医药卫生—药学]