摘要
目的探索艾司氯胺酮超前镇痛在全子宫切除术中的应用。方法选取北部战区总医院和平院区2021年6月至2022年6月择期全麻下行腹腔镜全子宫切除术的患者150例,年龄29~65岁,BMI 21~35 kg/m^(2),美国麻醉医师协会(ASA)Ⅱ~Ⅲ级。按照随机数字表分为生理盐水组(C组)、艾司氯胺酮0.25 mg/kg组(M组)和艾司氯胺酮0.5 mg/kg组(H组),每组50例。C组在气管插管后10 min静脉注射生理盐水10 ml,M组和H组则分别静脉注射艾司氯胺酮0.25 mg/kg和0.5 mg/kg。所有患者麻醉诱导、维持、术后镇痛用药完全一致。记录入室(T0)、输注生理盐水/艾司氯胺酮即刻(T1)、手术切皮(T2)、缝皮(T3)、气管拔管(T4)及出手术室时刻(T5)的心率(HR)和平均动脉压(MAP)。记录苏醒时间、拔管时间及术后2 h、4 h、6 h、8 h运动和静息视觉模拟评分(VAS评分),记录术后抢救性镇痛药物使用例数、术后患者自控静脉镇痛(PCIA)泵按压次数及术后恶心呕吐、呼吸抑制、心动过缓、寒战、嗜睡的发生率。结果在T0、T1、T2及T3时间点,三组HR与MAP差异无统计学意义(P>0.05),T4、T5时与C组相比,M组与H组的HR与MAP明显降低(P<0.05)。术后2 h时,三组的运动与静息VAS评分差异均无统计学意义(P>0.05),术后4 h和6 h时与C组相比,M组与H组的运动、静息VAS评分明显降低,且H组低于M组(P<0.05)。术后8 h时,C组与M组的运动、静息VAS评分差异无统计学意义(P>0.05),术后8 h,与M组相比,H组运动、静息VAS评分均明显降低(P<0.05)。与C组相比,M组与H组苏醒时间和拔管时间更短(P<0.05),而M组与H组苏醒时间与拔管时间差异无统计学意义(P>0.05)。与C组相比,M组与H组术后补救性镇痛例数与术后PCIA泵按压次数明显减少,且H组明显少于M组(P<0.05)。三组患者术后恶心呕吐、呼吸抑制、心动过缓、寒战及嗜睡发生率差异无统计学意义(P>0.05)。结论艾司氯胺酮可使腹腔镜下全子宫切除术中血
Objective To explore the application of esketamine preemptive analgesia in total hysterectomy.Methods A total of 150 patients,aged 29~65 years,BMI 21~35 kg/m^(2),ASA Grade Ⅱ~Ⅲ,underwent laparoscopic total hysterectomy under elective general anesthesia from June 2021 to June 2022 in Heping Hospital of Northern Theater Command General Hospital.According to the random number table,the patients were divided into three groups:normal saline group(group C),esketamine 0.25 mg/kg group(group M),esketamine 0.5 mg/kg group(group H),with 50 cases in each group.Group C was intravenously injected with 10 ml normal saline 10 min after endotracheal intubation,group M and group H were intravenously injected with esketamine 0.25 mg/kg and 0.5 mg/kg.Anesthesia induction,maintenance and postoperative analgesia were the same in all patients.HR and MAP were recorded on entry(T0),starting infusion of saline/esketamine(T1),surgical dermectomy(T2),suture(T3),tracheal extubation(T4),and exit from the operating room(T5).The recovery time,extubation time,visual analog score(VAS)of exercise and resting at 2 h,4 h,6 h,and 8 h after surgery,the number of cases receiving postoperative rescue analgesic drugs,the number of postoperative patient-controlled intravenous analgesia(PCIA)pump pressing,and the incidence of postoperative nausea and vomiting,respiratory depression,bradycardia,chills and drowsiness were recorded.Results At the time points of T0,T1,T2 and T3,there was no significant difference in HR and MAP among the three groups(P>0.05).Compared with group C,HR and MAP in group M and group H were significantly decreased at T4 and T5(P<0.05).Two hours after surgery,there were no significant difference in exercise and resting VAS scores among the three groups(P>0.05).Compared with group C,the scores of exercise and resting VAS in group M and group H at 4 h and 6 h after surgery were significantly decreased,and group H was lower than group M(P<0.05).At 8 h after surgery,the scores of exercise and resting VAS in group C and group M had no
作者
刘俊鹭
张晓东
邹彬
刁玉刚
张铁铮
孙莹杰
Liu Junlu;Zhang Xiaodong;Zou Bin;Diao Yugang;Zhang Tiezheng;Sun Yingjie(Department of Anesthesiology,General Hospital of the Northern Theater Command,Shenyang 110016,China)
出处
《实用药物与临床》
CAS
2023年第4期335-339,共5页
Practical Pharmacy and Clinical Remedies
关键词
艾司氯胺酮
术后镇痛
全子宫切除术
Esketamine
Postoperative analgesia
Total hysterectomy
