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| 术中持续泵注艾司氯胺酮对肺部手术患者术后痛觉过敏的影响 |
| Effect of continuous intraoperative infusion of esketamine on postoperative hyperalgesia in patients undergoing pulmonary surgery |
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| DOI：10.12089/jca.2024.12.009 |
| 中文关键词: 艾司氯胺酮 术后疼痛管理 肺部手术 睡眠 痛觉过敏 |
| 英文关键词: Esketamine Postoperative pain management Lung surgery Sleep Hyperalgesia |
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| 中文摘要: |
目的：观察术中持续泵注艾司氯胺酮对接受肺部手术患者术后痛觉过敏的影响。
方法：选择肺部择期手术患者70例，男36例，女34例，年龄18～64岁，BMI 18.5～28.0 kg/m 2，ASA Ⅱ或Ⅲ级。采用随机数字表法将患者分为两组：艾司氯胺酮组（E组，n=34）和对照组（C组，n=36）。E组于麻醉诱导时静脉注射艾司氯胺酮0.25 mg/kg，并持续静脉泵注0.15 mg·kg-1·h-1至手术结束前30 min。C组静脉输注等容量生理盐水。两组术中微量泵泵入丙泊酚6 mg·kg-1·h-1、瑞芬太尼0.1 μg·kg-1·min-1，术后行舒芬太尼患者自控静脉镇痛（PCIA）。记录术前1 d、术后2、24、48、72 h非优势手前臂和手术切口周围的机械痛阈，术后2、24、48、72 h痛觉过敏发生情况，术后2、24、48、72 h、7 d VAS疼痛评分，围术期吗啡毫克当量（MME）总量，镇痛泵有效和总按压次数，术后24 h内、术后25～72 h、73 h～7 d内补救镇痛次数，术前1 d和术后7 d入睡时间、睡眠时间和睡眠质量，术后7 d内幻觉、恶心呕吐、瘙痒、头晕、头痛、烦躁等不良反应发生情况。
结果：与C组比较，E组术后2、24 h时非优势手前臂和手术切口周围的机械痛阈明显升高（P＜0.05），术后48 h时手术切口周围的痛阈明显升高（P＜0.05），术后2、24 h非优势手前臂和手术切口周围痛觉过敏发生率明显降低（P＜0.05），术后12、24、48 h时E组静息和活动时VAS疼痛评分明显降低（P＜0.05），MME总量明显减少（P＜0.05），镇痛泵有效按压次数和总按压次数明显减少（P＜0.05），术后24 h内、术后25～72 h内补救镇痛率明显降低（P＜0.05），入睡时间明显缩短（P＜0.05），睡眠时间明显延长（P＜0.05），睡眠质量评分明显下降（P＜0.05）。术后7 d内两组幻觉、恶心呕吐、瘙痒、头晕、头痛、烦躁等不良反应发生率差异无统计学意义。
结论：术中泵注艾司氯胺酮0.15 mg·kg-1·h-1可有效缓解术后急性疼痛，减少阿片类药物的依赖并改善痛觉过敏，同时具有良好的安全性。 |
| 英文摘要: |
Objective: To observe the effects of esketamine on postoperative hyperalgesia in patients undergoing pulmonary surgery.
Methods: Seventy patients scheduled for elective pulmonary surgery were selected, including 36 males and 34 females, aged 18-64 years, BMI 18.5-28.0 kg/m 2, ASA physical status Ⅱ or Ⅲ. Patients were randomly divided into two groups using a random number table: the esketamine group (group E, n = 34) and the control group (group C, n = 36). Group E received an intravenous injection of esketamine at 0.25 mg/kg during anesthesia induction, followed by continuous infusion at 0.15 mg·kg-1·h-1 until 30 minutes before the end of surgery. Group C received an equivalent volume of normal saline. During surgery, both groups received propofol at 6 mg·kg-1·h-1 and remifentanil at 0.1 μg·kg-1·min-1 via micro-infusion pumps, followed by patient-controlled intravenous analgesia (PCIA) with sufentanil after surgery. Mechanical pain thresholds at the non-dominant forearm and around the surgical incision were measured 1 day before surgery and at 2, 24, 48, and 72 hours after surgery. The incidence of hyperalgesia was recorded at 2, 24, 48, and 72 hours post-surgery, along with VAS pain scores at 2, 24, 48, and 72 hours, and on 7 days after surgery. Total perioperative morphine milligram equivalent (MME) consumption and the number of successful and total PCIA attempts were also documented. Additionally, rescue analgesia use was recorded within 0-24 hours, 25-72 hours, and 73 hours to 7 days after surgery. Sleep parameters, including time to fall asleep, total sleep duration, and sleep quality, were assessed 1 day before and 7 days after surgery. Adverse reactions, such as hallucinations, nausea and vomiting, itching, dizziness, headache, and agitation, were monitored within 7 days after surgery.
Results: Compared with group C, group E showed a significant increase in the mechanical pain threshold at the non-dominant forearm and around the surgical incision at 2 and 24 hours postoperatively (P < 0.05) and a significant increase around the incision at 48 hours after surgery (P < 0.05). The incidence of hyperalgesia at the non-dominant forearm and the surgical incision was significantly lower in group E 2 and 24 hours postoperatively (P < 0.05). VAS pain scores, both at rest and during activity, were significantly lower in group E 12, 24, and 48 hours after surgery (P < 0.05). Group E also had significantly lower total MME consumption and fewer effective and total PCIA presses (P < 0.05). The frequency of rescue analgesia use was significantly reduced within 0-24 hours and 25-72 hours postoperatively (P < 0.05). Additionally, group E experienced a shorter time to fall asleep (P < 0.05), longer sleep duration (P < 0.05), but lower sleep quality scores (P< 0.05). There was no statistically significant difference between the two groups in the incidence of adverse reactions, such as hallucinations, nausea and vomiting, itching, dizziness, headache, and agitation, within 7 days postoperatively.
Conclusion: Intraoperative infusion of esketamine at a rate of 0.15 mg·kg-1·h-1 has been shown to effectively mitigate acute postoperative pain, reduce opioid dependence, and attenuate hyperalgesia, and exhibits a favorable safety profile. |
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