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| 艾司氯胺酮联合普瑞巴林对胸腔镜术后急慢性疼痛的影响 |
| Effect of esketamine combined with pregabalin on acute and chronic pain after video-assisted thoracoscopic surgery |
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| DOI：10.12089/jca.2023.12.006 |
| 中文关键词: 慢性疼痛 胸腔镜手术 普瑞巴林 艾司氯胺酮 |
| 英文关键词: Chronic pain Thoracoscopy Pregabalin Esketamine |
| 基金项目:无锡市科技发展医疗卫生项目（NZ2021035） |
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| 中文摘要: |
目的 观察围术期口服普瑞巴林联合术后艾司氯胺酮静脉镇痛对胸腔镜术后急慢性疼痛的影响。
方法 选择2020年9月至2021年8月择期全麻下行胸腔镜肺叶切除术患者129例，男68例，女61例，年龄18～80岁，BMI 15～30 kg/m2，ASA Ⅰ—Ⅲ级。采用随机数字表法将患者分为三组：艾司氯胺酮联合普瑞巴林组（PE组）、普瑞巴林组（P组）和对照组（C组），每组43例。PE组和P组术前1 h口服普瑞巴林150 mg，术后连续7 d口服普瑞巴林150 mg，每天2次。C组不口服普瑞巴林。PE组术后PCIA配方为：舒芬太尼100 μg、艾司氯胺酮1.25 mg/kg、托烷司琼4 mg加生理盐水至100 ml。P组和C组术后PCIA配方为：舒芬太尼100 μg、托烷司琼4 mg加生理盐水至100 ml。记录术后3、6、12、24、48 h静息和咳嗽时NRS疼痛评分。记录术中瑞芬太尼用量、术后0～12、12～24、24～48、0～48 h舒芬太尼用量、PCIA有效按压次数和总按压次数。记录术后48 h恶心、呕吐、头晕、瘙痒、幻觉和噩梦等不良反应发生情况。记录术后3、6个月慢性疼痛发生情况。
结果 与C组比较，PE组和P组术后3、6、12、24、48 h静息和咳嗽时NRS疼痛评分、术后0～12、12～24、24～48、0～48 h舒芬太尼用量、PCIA有效按压次数和总按压次数均明显减少（P<0.05）；PE组术后3、6个月慢性疼痛发生率明显降低（P<0.05）。与P组比较，PE组术后3、6个月慢性疼痛发生率明显降低（P<0.05）。三组术中瑞芬太尼用量、术后48 h恶心、呕吐、头晕、瘙痒、幻觉和噩梦等不良反应发生率差异均无统计学意义。
结论 围术期口服普瑞巴林联合术后艾司氯胺酮静脉镇痛可改善胸腔镜术后急性疼痛，减少术后阿片类药物用量，降低术后慢性疼痛发生率。 |
| 英文摘要: |
Objective To observe the effects of perioperative oral pregabalin combined with postoperative administration of esketamine on acute and chronic pain after thoracoscopy.
Methods A total of 129 patients undergoing elective thoracoscopic lobectomy under general anesthesia from September 2020 to August 2021, 68 males and 61 females, aged 18-80 years, BMI 15-30 kg/m2, ASA physical status Ⅰ-Ⅲ, were divided into three groups using random number table: esketamine combined with pregabalin group (group PE), pregabalin group (group P), and control group (group C), 43 patients in each group. Groups PE and P received 150 mg of oral pregabalin 1 hour before surgery and 150 mg of oral pregabalin continuously for 7 days after surgery, twice per day. Group C did not take pregabalin during the perioperative period. The analgesics of patient-controlled intravenous analgesia (PCIA) were sufentanil 100 μg + esketamine 1.25 mg/kg + tropisetron 4 mg with saline added to 100 ml in group PE, and sufentanil 100 μg + tropisetron 4 mg with saline added to 100 ml in groups P and C. The NRS pain scores at rest and during coughing were recorded 3, 6, 12, 24, and 48 hours after surgery. The effective press number of PCIA and the total press number of PCIA were recorded. The dosage of remifentanil, the cumulative sufentanil consumption were recorded during 0-12, 12-24, 24-48, and 0-48 hours after surgery. The adverse effects such as nausea, vomiting, dizziness, pruritus, hallucinations, and nightmares 48 hours after surgery were recorded. The incidences of chronic pain 3 and 6 months after surgery were recorded.
Results Compared with group C, the NRS pain scores 3, 6, 12, 24, and 48 hours after surgery, the cumulative sufentanil consumption during 0-12, 12-24, 24-48, and 0-48 hours after surgery, the effective press number of PCIA, the total press number of PCIA in groups PE and P were significantly decreased (P < 0.05), the incidences of chronic pain 3 and 6 months after surgery in group PE were significantly decreased (P < 0.05). Compared with group P, the incidences of chronic pain 3 and 6 months after surgery in group PE were significantly decreased (P < 0.05). There were no significant differences between the three groups in the dosage of remifentanil, and adverse effects such as nausea, vomiting, dizziness, pruritus, hallucinations, and nightmares 48 hours after surgery.
Conclusion Perioperative oral pregabalin combined with postoperative administration of esketamine can significantly decrease the incidence of chronic pain after thoracoscopy, reduce acute postoperative pain, and spare postoperative opioid usage． |
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