摘要
目的观察研究艾司氯胺酮对胸腔镜术后自控镇痛患者的作用效果。方法根据随机数字表法将在全身麻醉下行胸腔镜肺叶切除术患者120例分为S组、SK1组、SK2组和SK3组各30例。每组患者麻醉诱导及术中维持用药方案一致,术后均采用自控静脉镇痛,分别给予舒芬太尼2μg/kg、艾司氯胺酮1 mg/kg复合舒芬太尼2μg/kg、艾司氯胺酮1 mg/kg复合舒芬太尼1.5μg/kg、艾司氯胺酮1 mg/kg复合舒芬太尼1μg/kg静脉泵入。比较术后2 h(T1)、4 h(T2)、12 h(T3)、24 h(T4)和48 h(T5)NRS镇痛评分、Ramsay镇静评分,术前1天、术后2天的白细胞计数、中性粒细胞计数以及C反应蛋白(CRP)水平,比较48 h内镇痛泵按压次数及首次按压时间、不良反应发生率及患者满意度。结果在T3时点SK3组NRS评分高于S组,在T3、T4时点SK3组NRS评分高于SK1组和SK2组,SK1组NRS评分明显低于S组;在T2、T3时点,SK1组患者术后Ramsay评分较其他三组明显增高,在T4时,SK1组患者Ramsay评分明显高于SK3组;SK3组与其他三组比较,有效按压次数均增加,首次按压时间均提前;SK组术后白细胞计数、中性粒细胞计数和CRP水平较S组升高程度低;与S组和SK1组比较,SK2和SK3组术后不良反应发生率明显降低;SK2组满意度高于其他组。结论1 mg/kg的艾司氯胺酮复合1.5μg/kg的舒芬太尼不仅能给患者较为满意的镇痛效果,满足良好的镇静,还能降低术后不良反应的发生,患者的满意度较高。
Objective To investigate The effects of esketamine for patient-controlled intravenous analgesia(PCIA)in patients after thoracoscopic surgery.Methods One hundred and twenty patients who underwent thoracoscopic lobectomy surgery were selected.They were divided into a group S,group SK1,group SK2 and group SK3 using a random number table method,30 in each group.All patients received the same anesthesia induction and maintenance medication plan.PCIA was given after surgery.The group S was given sufentanil 2μg/kg,the group SK1 was given esketamine 1 mg/kg+sufentanil 2μg/kg,the group SK2 was given esketamine 1 mg/kg+sufentanil 1.5μg/kg and the group SK3 was given esketamine 1 mg/kg+sufentanil 1μg/kg.Related data such as NRS score and Ramsay score were recorded at 2 h(T1),4 h(T2),12 h(T3),24 h(T4)and 48 h(T5)after surgery.White blood cell count,neutrophil cell count and C-reaction protein(CRP)level were detected on the day before operation and after 2 days of operation.The first pressing time and the effective pressing numbers within 48 h,adverse reactions and degree of satisfaction were com-pared.Results At T3,the NRS score of group SK3 was significantly higher than group S.At T3 and T4,The NRS score of group SK3 was higher than group SK1 and group SK2.The NRS score of group SK1 was lower than group S.At T2 and T3,the Ramsay score of group SK1 was significantly higher than other groups.At T4,the Ramsay score of group SK1 was significantly higher than group SK3.The effective pressing numbers were increased and the first pressing time was advanced of group SK3.The white blood cell count,neu-trophil cell count and level of CRP had all increased after surgery.It was lower in group SK compared with group S.The incidence rate of postoperative adverse reactions of group SK2 and SK3 was significantly lower than group S and group SK1.Group SK2 had higher patient satisfaction than other three groups.Conclusions 1 mg/kg esketamine combined with 1.5 ug/kg sufentanil have satisfactory analgesic and sedative effect.This may reduce the inflammation stress and the incidence of adverse reactions.The method has high patient satisfaction.
作者
陈祖棋
张科
曾小莉
邬龄
田颖
CHEN Zu-qi;ZHANG Ke;ZENG Xiao-li;WU Ling;TIAN Ying(Department of Anesthesiology,The Second Affiliated Hospital of Chengdu Medical College/Nuclear Industry 416 Hospital,Chengdu 610051,China;Department of Second Outpatient,General Hospital of PLA West War Region,Chengdu 610041,China)
出处
《实用医院临床杂志》
2024年第3期102-106,共5页
Practical Journal of Clinical Medicine
基金
四川省中医药信息学会科研资助项目(编号:20210102)。
关键词
艾司氯胺酮
舒芬太尼
胸腔镜
自控镇痛
Esketamine
sufentanil
Thoracic Surgery,Video-Assisted
Analgesia,Patient-Controlled
