摘要
目的观察右旋氯胺酮复合舒芬太尼自控静脉镇痛(PCIA)用于腹腔镜直肠癌根治术老年患者的有效性和安全性,探讨对患者早期康复的影响。方法选取郑州大学附属肿瘤医院2020年12月至2021年3月择期行腹腔镜直肠癌根治术老年患者110例,随机数字表法分为2组(n=55):右旋氯胺酮复合舒芬太尼静脉自控镇痛组(S组)和单纯舒芬太尼静脉自控镇痛组(C组)。术毕行PCIA,S组镇痛泵配方:右旋氯胺酮1.44 mg/kg、舒芬太尼1.05 μg/kg、酮咯酸氨丁三醇2.0 mg/kg、托烷司琼5 mg,生理盐水稀释至100 ml;C组镇痛泵配方:舒芬太尼1.50 μg/kg、酮咯酸氨丁三醇2.0 mg/kg、托烷司琼5 mg,生理盐水稀释至100 ml。观察两组患者术后6、12、24、36和48 h疼痛视觉模拟评分(VAS)和Ramsay镇静评分。记录患者补救镇痛次数、术后48 h内镇痛泵有效按压次数,记录两组患者术后首次下床活动时间、首次排气时间及术后恢复进食时间。记录不良反应发生情况。结果研究过程中共剔除10例患者,其中4例中转开腹手术,3例中途退出研究,3例手术时间超过4 h。最终S组和C组各50例完成试验。两组患者术后6、12、24、36和48 h时VAS评分和Ramsay镇静评分差异均无统计学意义(均P>0.05)。两组患者补救镇痛次数和术后48 h内镇痛泵有效按压次数差异均无统计学意义(均P>0.05)。S组患者术后48 h舒芬太尼总用量为(64±9)μg,低于C组的(95±12)μg(P<0.001);术后首次下床活动时间为(1.1±0.2)d,早于C组的(1.6±0.5)d(P<0.001);术后首次排气时间为(1.3±0.4)d,早于C组的(1.8±0.6)d(P<0.001);术后首次进食时间为(2.5±0.6)d,早于C组的(3.1±0.7)d(P<0.001)。S组患者恶心、呕吐、皮肤瘙痒的发生率分别为4.0%、2.0%和0,均低于C组16.0%、10.0%和8.0%(均P<0.05)。两组患者均未出现噩梦、谵妄等精神症状。结论右旋氯胺酮复合舒芬太尼用于老年患者腹腔镜直肠癌根治手术镇痛效果良好,可减少
Objective To observe the efficacy and safety of S(+)-ketamine combined with sufentanil for patient-controlled intravenous analgesia(PCIA)in elderly patients undergoing laparoscopic radical resection of rectal cancer and explore its impact on patients′early recovery.Methods One hundred and ten patients undergoing laparoscopic radical resection of rectal cancer in Affiliated Cancer Hospital of Zhengzhou University from December 2020 to March 2021,were divided into two groups(n=55)using a random number table:group S received PCIA,with continuous infusion of S(+)-ketamine combined with sufentanil,while group C received PCIA,with continuous infusion of sufentanil.PCIA was initiated at the end of the surgery,and the formulations were as follows:group S,S(+)-ketamine(1.44 mg/kg),sufentanil(1.05μg/kg),ketorolac tromethamine(2.0 mg/kg)and tropisetron(5 mg),in 100 ml of normal saline;group C:sufentanil(1.50μg/kg),ketorolac tromethamine(2.0 mg/kg)and tropisetron(5 mg),in 100 ml of normal saline.Postoperative visual analogue scale(VAS)and Ramsay sedation scale were recorded at 6,12,24,36,48 h after the surgery.The incidence of remedial analgesia,the effective compressions number of PCI during 48 h after the operation.Time to first ambulation,time to first anal exhaust,time to resume oral feeding were recorded.The occurrence of adverse effects was compared between the two groups.Results A total of 10 patients were excluded during the study,including 4 cases of conversion to laparotomy,3 cases of dropping out of the study,and 3 cases with operation time more than 4 hours.Finally,50 cases in group S and 50 cases in group C completed the study.There were no significant differences in VAS scores and Ramsay sedation sores at all time points between two groups(all P>0.05).Likewise,there were also no significant differences in the number of remedial analgesia and effective compressions of PCIA during 48 h after the operation between the two groups(both P>0.05).The total dosage of sufentanil consumption in group S[(64±9)μg]was
作者
吕帅国
卢锡华
孙亚林
李鑫涛
缪长虹
Lyu Shuaiguo;Lu Xihua;Sun Yalin;Li Xintao;Miao Changhong(Department of Anesthesiology and Perioperative Medicine,Affiliated Cancer Hospital of Zhengzhou University,Zhengzhou 450008,China;Department of Anesthesiology,Zhongshan Hospital,Fudan University,Shanghai 200032,China)
出处
《中华医学杂志》
CAS
CSCD
北大核心
2021年第39期3238-3243,共6页
National Medical Journal of China
关键词
右旋氯胺酮
自控静脉镇痛
腹腔镜
直肠癌
早期康复质量
S(+)-ketamine
Patient-controlled intravenous analgesia
Laparoscopes
Rectal cancer
Quality of early recovery
