艾司氯胺酮复合舒芬太尼在腹腔镜下阑尾切除术患者中的应用效果  

Effect of esketamine combined with sufentanil in patients undergoing laparoscopic appendectomy

作　　者：赵星 王永胜 雷震营 信文启 Zhao Xing;Wang Yong-sheng;Lei Zhen-ying;Xin Wen-qi(Department of Anesthesiology,The Third People's Hospital of Kaifeng(The First People's Hospital of Xiangfu District),Kaifeng 475000,Henan,China;Department of General Surgery,The Third People's Hospital of Kaifeng(The First People's Hospital of Xiangfu District),Kaifeng 475000,Henan,China;Department of Anesthesiology,Huaihe Hospital,Henan University,Kaifeng 475000,Henan,China)

机构地区：[1]开封市第三人民医院(祥符区第一人民医院)麻醉科,河南开封475000 [2]开封市第三人民医院(祥符区第一人民医院)普外科,河南开封475000 [3]河南大学淮河医院麻醉科,河南开封475000

出　　处：《四川生理科学杂志》2025年第4期709-712,共4页

基　　金：河南省医学科技攻关计划联合共建项目(编号:LHGJ20201041)。

摘　　要：目的:探讨艾司氯胺酮复合舒芬太尼对腹腔镜下阑尾切除术(Laparoscopic appendectomy,LA)患者术后镇痛效果及对血流动力学的影响。方法:选取2022年1月至2024年2月开封市第三人民医院(祥符区第一人民医院)116例拟行LA的患者,随机分为对照组、复合组,各58例。两组手术方案、术中麻醉方案一致,术毕均安装静脉镇痛泵,其中对照组给予舒芬太尼镇痛,复合组给予艾司氯胺酮复合舒芬太尼镇痛。于术后3 h、6 h、12 h、24 h的采用视觉模拟评分(Visual analogue scale,VAS)评分、Ramasy评分评估两组疼痛及躁动程度,于术前(T0),术后4 h(T1)、术后8 h(T2)、术后16 h(T3)、术后32 h(T4)时采用病人监护仪监测两组心率、收缩压、舒张压,于T0-T4时采用化学发光法测定皮质醇(Cortisol,Cor)水平,采用酶联免疫吸附法测定促肾上腺皮质激素(Adrenocorticotropic hormone,ACTH)水平,于术后3 d、6 d、12 d采用恢复质量评分(Quality of recovery-15,QoR-15)评估两组恢复质量,记录对比两组舒芬太尼用量、PCA有效按压次数、不良反应总发生率。结果:复合组术后12 h、24 h的VAS、Ramasy评分低于对照组(P<0.05);复合组T1-T3的心率、收缩压、舒张压波动幅度小于对照组(P<0.05);复合组T1-T4时的Cor、ACTH水平低于对照组(P<0.05);复合组舒芬太尼用量、PCA有效按压次数低于对照组,且术后6 d、12 d的QoR-15评分高于对照组(P<0.05);两组不良反应发生率比较无明显差异。结论:艾司氯胺酮复合舒芬太尼可有效提升LA患者术后镇痛效果、稳定血流动力学、减轻应激水平、降低术后疼痛及躁动程度。Objective:To investigate the effect of esketamine combined with sufentanil on postoperative analgesia and hemodynamics in patients undergoing laparoscopic appendectomy(LA).Methods:A total of 116 patients scheduled to undergo LA in The Third People's Hospital of Kaifeng City(The First People's Hospital of Xiangfu District)from January 2022 to February 2024 were selected and randomly divided into a control group and a compound group,with 58 cases in each group.The two groups had the same surgical and anesthesia protocols,and both received intravenous analgesia pumps after surgery.The control group received sufentanil analgesia,while the combined group received esketamine combined with sufentanil analgesia.The degree of pain and restlessness in both groups was evaluated using the Visual analogue scale(VAS)and Ramasy score at 3 hours,6 hours,12 hours,and 24 hours after surgery.The heart rate,systolic blood pressure,and diastolic blood pressure were monitored using a patient monitor at pre-operative(T0),post-operative 4 hours(T1),post-operative 8 hours(T2),post-operative 16 hours(T3),and post-operative 32 hours(T4).The level of cortisol(Cor)was measured using chemiluminescence at T0-T4,and the level of adrenocorticotropic hormone(ACTH)was measured using enzyme-linked immunosorbent assay.The quality of recovery-15(QoR-15)was evaluated using the Quality of Recovery-15(QoR-15)at 3 days,6 days,,and 12 days,after surgery,and the total incidence of adverse reactions was recorded and compared between the two groups.Results:The VAS and Ramasy scores at 12 hours and 24 hours in the compound group were lower than those in the control group(P<0.05).The fluctuation range of heart rate,systolic blood pressure and diastolic blood pressure in T1-T3 group were lower than those in control group(P<0.05).The levels of Cor and ACTH in complex group at T1-T4 were lower than those in control group(P<0.05).The dosage of sufentanil and the number of effective PCA compressions in the compound group were lower than those in the control group,a

关 键 词：艾司氯胺酮 舒芬太尼 腹腔镜下阑尾切除术 镇痛 血流动力学 

分 类 号：R614[医药卫生—麻醉学]