亚麻醉剂量氯胺酮复合舒芬太尼对食管癌术后患者自控静脉镇痛的影响

摘要

目的：评价亚麻醉剂量氯胺酮复合舒芬太尼对食管癌根治术后患者自控静脉镇痛(PCIA)的影响。方法择期食管癌根治术患者90例,ASA Ⅰ或Ⅱ级,年龄55~75岁,随机分为 S1组、S2组和 SK 组,每组30例,术后行 PCIA,镇痛药配方分别为舒芬太尼2μg/kg(S1组),舒芬太尼2.5μg/kg(S2组),舒芬太尼2μg/kg+氯胺酮90μg·kg-1·h-1(S3组),各组镇痛药物均加入格拉司琼6 mg 并用生理盐水稀释至100 ml。所有患者均在手术结束前30 min 给予负荷量5 ml,连接静脉镇痛泵,记录患者术后4、8、24、48 h 的疼痛 VAS 评分、Ramsay 镇静评分、SBP、DBP、HR、SpO2及不良反应发生情况,并记录患者48 h 内按压 PCIA 总次数。结果三组患者术后4、8、24、48 h Ramsay镇静评分、SBP、DBP、HR、SpO2比较差异无统计学意义。S2组、SK 组患者48 h 内 VAS 评分明显低于、PCIA 按压总次数明显少于 S1组(P <0.05),SK 组患者48 h 内 VAS 评分明显低于、PCIA 按压总次数明显少于 S2组(P <0.05)。S2组患者术后48 h 内有2例发生呼吸抑制。结论亚麻醉剂量氯胺酮辅助舒芬太尼用于食管癌根治术患者,能减少术后舒芬太尼用量,缓解术后疼痛,镇痛效果优于单用舒芬太尼。%Objective To evaluate the effects of sub anesthetic dose of ketamine combined with sufentanil on postoperative patient-controlled intravenous analgesia (PCIA)in patients undergoing radical resection of esophageal cancer.Methods Ninety patients,ASAⅠorⅡ,aged 55-75 years old,se-lected for radical resection of esophageal cancer were randomly divided into three groups:group S1,group S2,group SK,30 patients in each group were treated with PCIA.Group S1,2 μg/kg sufentanyl;group S2,2.5 μg/kg sufentanyl;group SK 2 μg/kg sufentanyl+90 μg·kg-1·h-1 ketamine.6 mg of granisetron was added to each group,and then diluted into 100 ml of normal saline.All patients were administered load-ing doses of 5 ml analgesics 30 min before the end of the operation.The VAS score,Ramsay sedation score, SBP,DBP,HR,SpO2 and adverse effects were recorded respectively at 4,8,24 and 48 hours after opera-tion.The total times of pressing PCIA were also recorded in 48 h after operation.Results There was no statistically significant difference in Ramsay sedation score,SBP,DBP,HR and SpO2 at 4,8,24,48 hours after operation in the three groups.Compared with group S1,the VAS score and total number of pressing PCIA times in groups SK and S2 were significantly lower in 48 h after operation (P <0.05).Compared with group S2,VAS score and the total number of pressing PCIA times in group SK were significantly de-creased in 48 h after operation (P <0.05).Two patients from group SK occurred respiratory depression 48 h after operation.There was no statistically significant difference in incidence of adverse effects in the three groups.Conclusion Sub anesthetic dose of ketamine combined with sufentanil on PCIA can reduce postoper-ative sufentanil consumption and significantly relieve the postoperative pain in patients undergoing radical re-section of esophageal cancer.The analgesic effect is better than using sufentanil alone.