摘要
目的探讨围手术期应用亚麻醉剂量艾司氯胺酮对胸腔镜下肺手术患者术后急性疼痛和早期恢复质量的影响。方法选取行择期胸腔镜下肺手术的患者80例,按照随机数字表法分为艾司氯胺酮组(K组)和对照组(C组),每组40例。两组在实行标准化全麻方案基础上,K组于麻醉诱导后静脉注射艾司氯胺酮0.2 mg/kg,并以0.1 mg·kg^(−1)·h^(−1)持续静脉泵注至术毕,术后予患者自控静脉镇痛(patient controlled intravenous analgesia,PCIA):舒芬太尼0.03μg·kg^(−1)·h^(−1)+艾司氯胺酮0.015 mg·kg−1·h^(−1)。C组以同法输注等量生理盐水,术后予PCIA:舒芬太尼0.03μg·kg−1·h^(−1)。记录两组患者手术时间、麻醉时间、术中丙泊酚和瑞芬太尼用量及拔管时间;记录两组患者术后4、12、24 h及48 h静息与咳嗽时数字分级评分法(Numerical Rating Scale,NRS)疼痛评分;记录两组患者术前1 d、术后24 h和术后48 h 40项恢复质量量表(40⁃items Quality of Recovery Scale,QoR⁃40)评分;记录两组患者术后0~4 h、4~12 h、12~24 h、24~48 h及术后48 h内合计舒芬太尼用量;同时记录两组患者术后48 h内不良反应的发生情况。结果与C组比较,K组术后12 h咳嗽NRS疼痛评分降低(P<0.05),术后24 h和术后48 h QoR⁃40评分均升高(P<0.05),术后48 h内合计舒芬太尼用量降低(P<0.05);其余指标比较差异均无统计学意义(P>0.05)。两组患者术后48 h内不良反应发生率比较差异均无统计学意义(P>0.05)。结论围手术期应用亚麻醉剂量艾司氯胺酮能够缓解胸腔镜下肺手术患者术后急性疼痛,减少术后阿片类药物的使用量,促进早期恢复。
Objective To investigate the effect of perioperative application of a subanesthetic dose of esketamine on acute pain and early recovery quality of patients undergoing thoracoscopic lung surgery.Methods A total of 80 patients who were sched⁃uled for thoracoscopic lung surgery were selected.According to the random number table method,they were divided into two groups(n=40):an esketamine group(group K)and a control group(group C).On the basis of standardized general anesthesia program,group K was intravenously injected with esketamine at 0.2 mg/kg after anesthesia induction,followed by continuous intravenous pumping at 0.1 mg·kg^(−1)·h^(−1)until the end of surgery,while patient-controlled intravenous analgesia(PCIA,sufentanil 0.03μg·kg^(−1)·h^(−1)+esket⁃amine 0.015 mg·kg^(−1)·h^(−1))was given after surgery.Group C was infused with an equal volume of normal saline at the same rate,fol⁃lowed by postoperative PCIA(sufentanil at 0.03μg·kg^(−1)·h^(−1)).Then,their operation time,anesthesia time,the intraoperative dosages of propofol and remifentanil,and extubation time were recorded.Both groups were compared for the Numerical Rating Scales(NRS)scores at rest and during coughing at postoperative 4,12,24 h and 48 h.The scores of 40-items Quality of Recovery Scale(QoR-40)were recorded one day before surgery,and at postoperative 24 h and 48 h.The consumption of sufentanil within postoperative 0‒4 h,4‒12 h,12‒24 h,24‒48 h and 48 h and adverse reactions within 48 h after surgery were recorded.Results Compared with group C,group K showed decreased NRS scores at coughing at postoperative 12 h(P<0.05),increased QoR-40 scores at postoperative 24‒48 h(P<0.05),and decreased consumption of sufentanil within postoperative 48 h(P<0.05),without statistical differences in other indexes(P>0.05).There was no statistical difference in adverse reaction incidence within postoperative 48 h between the two groups(P>0.05).Conclusions Perioperative application of a subanesthetic dose of esketamine in patients undergoing thoracoscopic lung surgery can alleviate acute pain after surgery,reduce the usage of opioids and promote early recovery quality.
作者
潘壮
罗小雨
李倩
熊苗苗
刘尧
张中军
Pan Zhuang;Luo Xiaoyu;Li Qian;Xiong Miaomiao;Liu Yao;Zhang Zhongjun(School of Anesthesiology,Xuzhou Medical University,Xuzhou 221004,China;Department of Anesthesiology,the Affiliated Hospital of Jiangnan University,Wuxi 214122,China;Department of Pain Management,the Affiliated Hospital of Jiangnan University,Wuxi 214062,China)
出处
《国际麻醉学与复苏杂志》
CAS
2023年第5期462-466,共5页
International Journal of Anesthesiology and Resuscitation
基金
无锡卫健委重大项目(Z202117)。
