| 孔 鹏,王德伟,梁映霞,陈康康,张艺佳.艾司氯胺酮超前镇痛和自控镇痛联合应用于腹腔镜结直肠癌根治术患者的术后镇痛效果以及早期康复效果研究[J].,2023,(1):146-151 |
| 艾司氯胺酮超前镇痛和自控镇痛联合应用于腹腔镜结直肠癌根治术患者的术后镇痛效果以及早期康复效果研究 |
| Study on the Postoperative Analgesia Effect and Early Rehabilitation Effect of Combination of Esketamine and Patient-Controlled Analgesia in Patients Undergoing Laparoscopic Radical Resection for Colorectal Cancer |
| 投稿时间：2022-04-18 修订日期：2022-05-14 |
| DOI：10.13241/j.cnki.pmb.2023.01.029 |
| 中文关键词: 腹腔镜结直肠癌根治术 艾司氯胺酮 超前镇痛 自控镇痛 |
| 英文关键词: Laparoscopic radical resection of colorectal cancer Esketamine Preemptive analgesia Postoperative patient-controlled analgesia |
| 基金项目:国家自然科学基金项目（81300969） |
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| 中文摘要: |
| 摘要 目的：观察艾司氯胺酮超前镇痛和自控镇痛联合应用于腹腔镜结直肠癌根治术患者的术后镇痛效果，并探讨其对患者术后早期康复的影响。方法：将100例接受腹腔镜结直肠癌根治术治疗的患者随机分为两组：无预处理组（C组，n=50）和预先应用艾司氯胺酮超前镇痛组（S组，n=50）。S组患者麻醉诱导前20 min单次静脉注射0.3 mg/kg艾司氯胺酮，0～3 min内注射完毕，手术开始后以300 ?滋g/（kg?h）的速度泵注至手术结束前15 min。C组使用等量生理盐水替代，其余麻醉诱导和维持方案相同。术毕患者清醒后行相同的静脉自控镇痛（PCIA），记录术后各时间点镇痛泵中舒芬太尼的用量。采用视觉模拟评分法（VAS）评估两组患者术后各时间点的疼痛，采用改良警觉/镇静评分（MOAA/S）量表评估两组患者术后各时间点的镇静情况；观察并记录患者术后情绪状态、苏醒时间、首次排气时间、首次下床活动时间及不良反应。结果：术后1、3、6 h，S组镇痛泵中舒芬太尼用量明显少于C组（P＜0.05）。静息状态下S组患者在术后1 h VAS评分低于C组（P＜0.05）；活动状态下S组患者术后1 h、3 h的VAS评分低于C组（P＜0.05）；S组患者在术后15 min时MOAA/S量表评分显著低于C组（P＜0.05）。S组患者的情绪状态好于C组患者（P＜0.05）；S组术后首次排气时间和首次下床活动时间显著短于C组（P＜0.05），两组患者苏醒时间比较未见显著性差异（P>0.05）； S组术后寒战发生率明显低于C组（P<0.05）。结论：艾司氯胺酮超前镇痛和自控镇痛联合应用于腹腔镜结直肠癌根治术，可以在术后早期提供更好的镇痛和镇静效果，改善术后患者的情绪状态，降低术后寒战的发生率并促进患者术后尽快排气，有助于患者的早期康复。 |
| 英文摘要: |
| ABSTRACT Objective: To observe the postoperative analgesia effect of combination of esketamine and patient-controlled analgesia in patients undergoing laparoscopic radical resection of colorectal cancer, and to explore its effect on the early rehabilitation of patients. Methods: 100 patients undergoing laparoscopic radical resection for colorectal cancer were randomly divided into two groups: no pretreatment group(group C, n=50)and pre application of esketamine supra analgesia group(group S, n=50). Patients in group S received a single intravenous injection of 0.3 mg/kg esketamine 20 min before anesthesia induction, and the injection was completed within 0～3 min. After operation, the patients were treated with 300 ?滋g/(kg?h) esketamine until 15 min before the end of the operation. Group C was replaced with the same amount of normal saline, and the other anesthesia induction and maintenance protocols were the same. The same patient-controlled intravenous analgesia(PCIA) was performed after the patients were awake after operation, and the dosage of sufentanil in the analgesia pump at each time point after operation was recorded. Visual analog scale(VAS) was used to evaluate the pain of the two groups at various time points after operation, and the Modified Observer's Assessment of Alertness and Sedation(MOAA/S) was used to evaluate the sedation of the two groups at various time points after operation. The patients' emotional state, recovery time, first exhaust time, first ambulation time and adverse reactions were observed and recorded. Results: At 1,3 and 6 h after operation, the dosage of sufentanil in analgesic pump in the group S was significantly less than that in the group C(P<0.05). At rest, the VAS score in the group S was lower than that in the group C at 1h after operation(P<0.05). The VAS scores in the group S at 1 h and 3 h after operation were lower than those in the group C(P<0.05). The score of MOAA/S scale in the group S was significantly lower than that in the group C at 15 min after operation(P<0.05). The emotional state of patients in the group S was better than that the in group C (P<0.05). The first exhaust time and the first ambulation time in the group S were significantly shorter than those the in group C (P<0.05), and there was no significant difference in the recovery time between the two groups(P>0.05). The incidence of postoperative shivering in the group S was significantly lower than that in the group C(P<0.05). Conclusion: The combination of esketamine pre-analgesia and patient-controlled analgesia in laparoscopic radical resection of colorectal cancer can provide better analgesic and sedative effects in the early postoperative period, improve the postoperative emotional state of patients,reduce the incidence of postoperative shivering,promote the exhaust as soon as possible, and contribute to the early recovery of patients. |
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