艾司氯胺酮联合舒芬太尼术后镇痛用于乳腺癌改良根治术的效果

何会珍; 王学然; 高宁; 王志存; 管小萌; 王梦迪; 闫亚萍

艾司氯胺酮联合舒芬太尼术后镇痛用于乳腺癌改良根治术的效果

Effect of Esketamine combined with Sufentanil for postoperative analgesia in modified radical resection of breast cancer

摘要

摘要:
目的： 探讨艾司氯胺酮联合舒芬太尼术后镇痛用于乳腺癌改良根治术的安全性及有效性。
方法： 选取行乳腺癌改良根治术病人102例，随机分为观察组和对照组，各51人。2组病人均采用全身麻醉，术后应用肌内病人自控镇痛。观察组术后镇痛采用艾司氯胺酮1 mg/kg + 舒芬太尼1 μg/kg + 昂丹司琼16 mg，对照组采用舒芬太尼2 μg/kg + 昂丹司琼16 mg，均以0.9%氯化钠溶液稀释至100 mL。分别观察2组术后2 h（T1）、6 h（T2）、12 h（T3）、24 h（T4）、48 h（T5）时VAS评分与Ramsay镇静评分，比较2组术前（T0）和T4、T5时失眠严重程度指数量表（ISI）、焦虑自评量表（SAS）、抑郁自评量表（SDS）评分和术后睡眠障碍发生情况，记录术后镇痛泵按压次数、术后胃肠恢复时间和不良反应发生情况。
结果： 观察组病人术后T1 ~ T5时VAS评分和T1 ~ T4时Ramsay评分均低于对照组（P ＜ 0.05 ~ P ＜ 0.01）。2组病人T0时SAS、SDS和ISI评分差异均无统计学意义（P ＞ 0.05）；观察组T4、T5时SAS、SDS和ISI评分均低于对照组（P ＜ 0.05 ~ P ＜ 0.01）。观察组病人术后肛门排气时间和镇痛泵按压、追加氟比洛芬酯补救镇痛次数及睡眠障碍发生率均少于对照组（P ＜ 0.05 ~ P ＜ 0.01）。2组病人术后均未出现呼吸抑制，观察组术后头晕和皮肤瘙痒发生率均低于对照组（P ＜ 0.01和P ＜ 0.05）。
结论： 艾司氯胺酮联合舒芬太尼用于乳腺癌改良根治术后镇痛效果确切，能改善病人术后睡眠质量及焦虑、抑郁情绪，且不良反应发生率低。

Abstract:
Objective To investigate the safety and efficacy of Esketamine combined with Sufentanil for postoperative analgesia in modified radical resection of breast cancer.
Methods A total of 102 patients treated with modified radical mastectomy were randomly divided into the observation group (AS) and control group (S) (51 case each group). Two groups were given the general anesthesia and intramuscular patient-controlled analgesia after surgery. The postoperative analgesia was administered with 1 mg/kg Esketamine, 1 μg/kg Sufentanil and 16mg Ondansetron in the observation group, and 2 μg/kg Sufentanil and 16 mg Ondansetron diluted to 100 mL in 0.9% sodium chloride solution in the control group. The VAS score and Ramsay sedation score were observed afetr 2 h (T1), 6 h (T2), 12 h (T3), 24 h (T4) and 48 h (T5) of operation in two groups. The scores of insomnia Severity scale (ISI), self-rating Anxiety Scale (SAS) and self-rating Depression Scale (SDS) before surgery (T0) and at T4 and T5, and postoperative sleep disorders were compared between two groups. The number of postoperative analgesic pump compression, postoperative gastrointestinal recovery time and occurrence of adverse reactions were recorded in two groups.
Results The VAS score at T1 ~ T5 and Ramsay score at T1 ~ T4 in the observation group were lower than those in control group (P ＜ 0.05 ~ P ＜ 0.01). There was no statistical significance in the SAS, SDS and ISI scores at T0 between two groups (P ＞ 0.05). The scores of SAS, SDS and ISI at T4 and T5 in the observation group were lower than those in control group (P ＜ 0.05 ~ P ＜ 0.01). The time of anal exhaust, number of analgesic pump compression, number of additional flurbiprofen exfoliate analgesia and incidence of sleep disturbance in the observation group were lower than those in control group (P ＜ 0.05 ~ P ＜ 0.01). There was no respiratory depression in two groups after operation, and the incidence rate of dizziness and skin pruritus in the observation group was lower than that in control group (P ＜ 0.01 and P ＜ 0.05).
Conclusions Esketamine combined with Sufentanil has a definite analgesic effects after modified radical surgery of breast cancer, and can improve postoperative sleep quality, anxiety and depression, and the incidence of adverse reactions is low.

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