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| 艾司氯胺酮与硫酸镁用于腹腔镜全子宫切除术后镇痛效果的比较 |
| Effect of esketamine and magnesium sulfate on postoperative analgesia in patients undergoing laparoscopic total hysterectomy |
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| DOI：10.12089/jca.2023.09.002 |
| 中文关键词: 艾司氯胺酮 硫酸镁 术后镇痛 腹腔镜全子宫切除术 患者自控静脉镇痛 |
| 英文关键词: Esketamine Magnesium sulfate Postoperative analgesia Laparoscopic total hysterectomy Patient-controlled intravenous analgesia |
| 基金项目:国家自然科学基金青年基金（82001189）；河南省省部共建项目（11225） |
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| 中文摘要: |
目的 观察和比较艾司氯胺酮与硫酸镁用于腹腔镜全子宫切除术后镇痛的效果。
方法 选择择期在全麻下行腹腔镜全子宫切除术患者135例，年龄18～64岁，BMI 18.5～28.0 kg/m2，ASA Ⅰ或Ⅱ级。采用随机数字表法将患者随机分为两组：艾司氯胺酮组（E组，n=67）和硫酸镁组（M组，n=68）。E组在手术开始前静脉注射艾司氯胺酮0.25 mg/kg，随后持续静脉泵注0.15 mg·kg-1·h-1；M组在手术开始前静脉注射硫酸镁50 mg/kg，随后持续静脉泵注8 mg·kg-1·h-1。术后行患者自控静脉镇痛（PCIA），配方为氢吗啡酮0.1 mg/kg+帕洛诺司琼0.25 mg。记录术中丙泊酚、瑞芬太尼用量和苏醒时间。记录术后2、6、12、24、48 h氢吗啡酮消耗量（等效界值为0.25 mg）、静息和活动时VAS疼痛评分。记录术后0~2 h、2~6 h、6~12 h、12~24 h和24~48 h内镇痛泵按压次数。记录术后补救镇痛、术后24 h内不良反应发生情况。
结果 与M组比较，E组术中丙泊酚及瑞芬太尼用量明显增加（P＜0.05），苏醒时间明显延长（P＜0.05）。两组术后2、6、12、24、48 h氢吗啡酮消耗量、静息和活动时VAS疼痛评分、术后0~2 h、2~6 h、6~12 h、12~24 h和24~48 h内镇痛泵按压次数、术后补救镇痛率和术后24 h内不良反应发生率差异无统计学意义。
结论 艾司氯胺酮可为腹腔镜全子宫切除术患者提供与硫酸镁相似的术后镇痛效果。 |
| 英文摘要: |
Objective To observe and compare the postoperative analgesic effect of esketamine and magnesium sulfate for laparoscopic total hysterectomy.
Methods A total of 135 patients, aged 18 - 64 years, BMI 18.5-28.0 kg/m2, ASA physical status Ⅰ or Ⅱ, undergoing elective laparoscopic total hysterectomy were selected. The patients were divided into two groups by random number table method: esketamine group (group E, n = 67) and magnesium sulfate group (group M, n = 68). The patients in group E received esketamine 0.25 mg/kg intravenously before the operation, followed by continuous infusion 0.15 mg·kg-1·h-1. The patients in group M received magnesium sulfate 50 mg/kg intravenously before the operation, followed by continuous infusion 8 mg·kg-1·h-1. The patients were given patient-controlled intravenous analgesia (PCIA) pump with hydromorphine 0.1 mg/kg and palonosetron 0.25 mg after operation. The consumption of remifentanil and propofol during operation, and awakening time were recorded. The consumption of hydromorphine in PCIA pump and VAS pain scores at rest and in activity 2, 6, 12, 24, and 48 hours after operation were also recorded. Analgesic pump press times at 0-2, 2-6, 6-12, 12-24, and 24-48 hours after surgery were recorded. The incidence of rescue analgesia and adverse reactions were also recorded.
Results Compared with group M, the dosage of propofol and remifentanil during operation in group E were significantly increased, and the recovery time in group E was significantly prolonged (P < 0.05). There were no significant differences between the two groups in the consumption of hydromorphine, and VAS pain scores at rest and in activity 2, 6, 12, 24, and 48 hours after operation, analgesic pump press times at 0-2, 2-6, 6-12, 12-24, 24-48 hours after surgery, postoperative rescue analgesia rate, and incidence of adverse reactions within 24 hours after surgery.
Conclusion Esketamine can provide postoperative analgesic effects similar to magnesium sulfate for patients undergoing laparoscopic total hysterectomy. |
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