小剂量艾司氯胺酮防治瑞芬太尼全身麻醉后痛觉过敏的临床观察

冯涛; 刘刚; 余向天; 李敏; 陶静; 梁启胜

doi:10.16766/j.cnki.issn.1674-4152.003704

小剂量艾司氯胺酮防治瑞芬太尼全身麻醉后痛觉过敏的临床观察

doi: 10.16766/j.cnki.issn.1674-4152.003704

蚌埠医科大学第一附属医院麻醉科，安徽蚌埠 233004

基金项目:

安徽省高校自然科学研究重点项目 KJ2021A0785

蚌埠医学院自然科学重点项目 2021byzd127

详细信息

通讯作者:
梁启胜，E-mail: bbyemenlqs@126.com

中图分类号: R737.33 R971.2
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- 文章访问数: 12
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出版历程
- 收稿日期: 2024-02-18
- 网络出版日期: 2024-12-28

Clinical observation of low-dose esketamine for the prevention and treatment of hyperalgesia after remifentanil general anesthesia

Department of Anesthesiology, the First Affiliated Hospital of Bengbu Medical University, Bengbu, Anhui 233004, China

摘要

摘要: 目的探讨小剂量艾司氯胺酮对瑞芬太尼全麻后痛觉过敏发生率、疼痛程度、镇痛药用量及安全性的影响。方法选择2021年12月—2022年9月就诊于蚌埠医科大学第一附属医院择期行子宫颈癌根治术的患者80例。采用随机数字表法将患者分为艾司氯胺酮组(E组)和对照组(C组)，每组40例。2组诱导及维持方法相同，E组诱导后给予艾司氯胺酮0.12 mg/(kg·h)静脉泵注，C组泵注等量生理盐水。记录2组患者不同时间点的平均动脉压(MAP)和心率(HR)；术后痛觉过敏发生率；首次疼痛时间、即时VAS评分和OAA/S评分；术后镇痛泵使用情况及不良反应。结果 E组T3~T6时点的MAP均高于C组(P＜0.05)；E组T3~T6时点的HR均高于C组(P＜0.05)；术后E组出现痛觉过敏4例，发生率为10%，C组出现16例，发生率为40%，E组痛觉过敏发生率更低，差异有统计学意义(P＜0.05)；相比C组，E组术后首次疼痛时间[(138.75±16.67)min vs. (40.75±26.15)min]发生更晚，即时VAS评分更低[(3.35±0.53)分vs. (4.60±0.87)分], 即时OAA/S评分[(4.08±0.76)分vs. (3.60±0.93)分]较高，差异有统计学意义(P＜0.05)；2组术后镇痛相比，E组术后镇痛泵中药液使用量少，术后镇痛满意，差异有统计学意义(P＜0.05)；2组术后总不良反应发生率比较，差异无统计学意义(P＞0.05)。结论艾司氯胺酮应用于宫颈癌根治术患者，术中血流动力学稳定、术后镇痛满意，能够有效防治瑞芬太尼引起的痛觉过敏。
- 艾司氯胺酮 /
- 痛觉过敏 /
- 瑞芬太尼 /
- 术后镇痛
Abstract: Objective To investigate the effects of low-dose esketamine on the incidence of nociceptive hypersensitivity, pain level, analgesic dosage, and safety after remifentanil general anesthesia. Methods Eighty patients who attended the First Affiliated Hospital of Bengbu Medical University for elective radical cervical cancer surgery from December 2021 to September 2022 were selected. The patients were divided into the esketamine group (Group E) and the control group (Group C) using the randomized numerical table method, with 40 cases in each group. The induction and maintenance methods were the same in both groups, with esketamine 0.12 mg/(kg·h) intravenously pumped after induction in Group E and an equal amount of saline pumped in Group C. Mean arterial pressure (MAP) and heart rate (HR) at different time points, incidence of postoperative nociceptive hypersensitivity, time to first pain, immediate VAS score and OAA/S score, postoperative analgesic pump use, and adverse reactions were recorded in both groups. Results The MAP at the time points of T3 to T6 in the group E which were higher than that in the group C (P < 0.05); the HR at the time points of T3 to T6 in group E which were higher than that of Group C (P < 0.05); 4 cases of nociceptive allergy appeared in Group E after operation, with an incidence rate of 10%, and 16 cases appeared in the Group C, with an incidence rate of 40%. The incidence rate of nociceptive allergy in the Group E was lower than that in the Group C. The difference was statistically significant (P < 0.05). Compared with group C, the first postoperative pain occurred later in group E [(138.75±16.67) min vs. (40.75±26.16) min], the immediate VAS score was lower (3.35±0.53 vs. 4.60±0.87), and the immediate OAA/S score was higher (4.08±0.76 vs. 3.60±0.93), with statistically significant differences (P < 0.05), and analgesic pump in group E used less medicinal fluid and had satisfactory postoperative analgesia, and the difference was significant (P < 0.05). There is no significant difference in the postoperative adverse reactions between the two groups (P>0.05). Conclusion The application of esketamine in patients undergoing radical surgery for cervical cancer resulted in stable intraoperative hemodynamics and satisfactory postoperative analgesia and was able to effectively prevent and control remifentanil-induced nociceptive hypersensitivity.
- Esketamine /
- Hyperalgesia /
- Remifentanil /
- Postoperative analgesia

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表 1 2组子宫颈癌患者一般情况比较

Table 1. General comparison of cervical cancer patients in the two groups

组别	例数	年龄(x±s，岁)	BMI(x±s)	ASA分级(Ⅱ/Ⅲ级，例)	手术时间(x±s，min)	瑞芬太尼用量(x±s，mg)
E组	40	57.70±8.86	23.30±3.72	24/16	204.75±16.75	3.91±0.09
C组	40	55.55±8.04	23.08±3.74	37/16	202.13±17.37	3.82±0.10
统计量		1.136^a	0.261^a	0.691^b	0.688^a	0.706^a
P值		0.259	0.759	0.492	0.493	0.482
注：^a为t值，^b为χ²值。

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表 2 2组子宫颈癌患者不同时间点HR比较(x±s，次/min)

Table 2. HR comparison between the two groups of cervical cancer patients at different time points(x±s, times/min)

组别	例数	T0	T1	T2	T3	T4	T5	T6
E组	40	74.90±12.65	68.62±7.53^a	81.88±10.3^ab	75.25±11.89^bc	72.63±9.83^c	74.18±10.34^bc	82.98±12.12^bdef
C组	40	78.13±9.83	67.00±9.02^a	86.55±13.53^b	68.20±11.22^ac	63.78±10.07^ac	65.58±10.83^ac	75.83±9.65^bcdef
F值		-1.274	0.874	-1.739	2.728	3.978	3.633	4.306
P值		0.207	0.385	0.086	0.008	＜0.001	＜0.001	＜0.001
注：与同组T0比较，^aP＜0.05；与同组T1比较，^bP＜0.05；与同组T2比较，^cP＜0.05；与同组T3比较，^dP＜0.05；与同组T4比较，^eP＜0.05；与同组T5比较，^fP＜0.05。

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表 3 2组子宫颈癌患者不同时间点MAP比较(x±s，mmHg)

Table 3. MAP comparison between the two groups of cervical cancer patients at different time points(x±s, mmHg)

组别	例数	T0	T1	T2	T3	T4	T5	T6
E组	40	94.32±13.36	85.53±15.13	106.48±12.25^ab	97.28±10.19^bc	94.40±9.56^bc	98.03±8.09^bc	102.05±9.42^ab
C组	40	98.37±9.66	80.20±12.62^a	104.35±11.92^b	78.60±8.66^ac	78.07±13.22^ac	80.02±11.47^ac	86.3±10.87^acd
F值		0.210	-1.554	1.709	0.786	8.833	6.327	8.110
P值		0.124	0.091	0.434	＜0.001	＜0.001	＜0.001	＜0.001
注：与同组T0比较，^aP＜0.05；与同组T1比较，^bP＜0.05；与同组T2比较，^cP＜0.05；与同组T3比较，^dP＜0.05。

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表 4 2组子宫颈癌患者术后首次疼痛时间及程度、首次疼痛OAA/S评分、镇痛泵使用情况比较(x±s)

Table 4. Comparison of the time and extent of first postoperative pain, OAA/S score of first postoperative pain, and analgesic pump usage between the two groups of cervical cancer patients(x±s)

组别	例数	术后首次疼痛时间(min)	首次疼痛VAS评分(分)	首次疼痛OAA/S评分(分)	镇痛泵药液消耗总量(mL)
组别	例数	术后首次疼痛时间(min)	首次疼痛VAS评分(分)	首次疼痛OAA/S评分(分)	3 h	6 h	12 h	24 h
E组	40	138.75±16.67	3.35±0.53	4.08±0.76	9.40±2.09	17.85±3.18	32.75±4.09	58.55±4.53
C组	40	40.75±26.15	4.60±0.87	3.60±0.93	12.50±3.06	28.35±5.14	43.90±5.22	71.90±5.45
统计量		19.984^a	7.739^a	2.499^a	-5.291^b	-10.981^b	-10.628^b	-11.912^b
P值		＜0.001	＜0.001	0.015	＜0.001	＜0.001	＜0.001	＜0.001
注：^a为t值，^b为F值。

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表 5 2组子宫颈癌患者术后痛觉过敏发生情况(例)

Table 5. Occurrence of postoperative hyperalgesia in the two groups of cervical cancer patients (cases).

组别	例数	疼痛发生区域扩大	切口局部持续剧烈疼痛，VAS＞8分	触、冷诱发痛	疼痛程度与临床情况严重不符	肢体保护性动作存在	VAS评分持续＞8分	术后需要麻醉医生处理
C组	40	10	2	5	4	6	2	3
E组	40	4	0	3	2	0	0	0

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表 6 2组子宫颈癌患者术后不良反应发生情况比较(例)

Table 6. Comparison of postoperative adverse reactions in the two groups of cervical cancer patients (cases)

组别	例数	POD	嗜睡	头晕	PONV	皮肤瘙痒	合计
E组	40	1	0	1	2	0	4
C组	40	0	1	0	5	0	6
注：2组总不良反应发生率比较，χ²=0.457，P=0.499。

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