小剂量艾司氯胺酮对卵巢良性肿瘤腹腔镜切除术患者瑞芬太尼诱发痛觉过敏的影响

Effects of low-dose esketamine on remifentanil-induced hyperalgesia in patients with benign ovarian tumors undergoing laparoscopic resection

摘要:

目的 探讨小剂量艾司氯胺酮对卵巢良性肿瘤腹腔镜切除术患者瑞芬太尼诱发痛觉过敏的影响。方法 选取2019年1月—2021年3月南通大学附属妇幼保健院收治的123例拟行腹腔镜切除术治疗的卵巢良性肿瘤患者，采用随机分组方法分为A组、B组及C组，每组41例。麻醉诱导后，A组和B组分别给予艾司氯胺酮0.8 mg/kg、0.6 mg/kg静脉输注（15 min输注完毕），C组不给予艾司氯胺酮。比较3组患者手术时间、苏醒时间、拔管时间及24 h吗啡累积用量；比较3组患者不同时间点血流动力学指标（心率、平均动脉压）、疼痛应激指标［前列腺素E2（PEG2）、P物质（SP）］及视觉模拟评分法（VAS）评分；比较3组患者住院期间不良反应。结果 3组患者手术时间、拔管时间及24 h吗啡累积用量比较，差异无统计学意义（P >0.05）；3组患者苏醒时间比较，差异有统计学意义（P <0.05），B组苏醒时间短于A组和C组。3组患者不同时间点心率和平均动脉压比较结果：①不同时间点的心率和平均动脉压比较有差异（P <0.05）；②3组的心率和平均动脉压比较有差异（P <0.05），B组术中30 min、术后1 h的心率慢于A组和C组，平均动脉压低于A组和C组；③3组的心率和平均动脉压变化趋势有差异（P <0.05）。3组患者不同时间点PEG2、SP水平比较结果：①不同时间点的PEG2、SP水平有差异（P <0.05）。②3组的PEG2、SP水平有差异（P <0.05），A组和B组术中、术后1 h PEG2、SP水平均低于C组（P <0.05）。③3组的PEG2、SP水平变化趋势有差异（P <0.05）。3组患者不同时间点VAS评分比较结果：①不同时间点的VAS评分有差异（P <0.05）；②3组的VAS评分有差异（P <0.05），A组和B组术后6 h、术后12 h VAS评分低于C组（P <0.05）；③3组的VAS评分变化趋势有差异（P <0.05）。3组患者总不良反应发生率比较，差异无统计学意义（P >0.05）。结论 卵巢良性肿瘤腹腔镜切除术患者采用0.8 mg/kg、0.6 mg/kg剂量的艾司氯胺酮均可有效预防瑞芬太尼诱发痛觉过敏，降低疼痛且安全可靠，但0.6 mg/kg剂量艾司氯胺酮在缩短苏醒时间、血流动力学稳定性方面优于0.8 mg/kg剂量。

Abstract:

Objective To investigate the effect of low-dose esketamine on remifentanil-induced hyperalgesia in patients with benign ovarian tumors undergoing laparoscopic resection.Methods A total of 123 patients with benign ovarian tumors who were treated by laparoscopic resection in Maternal and Child Health Hospital Affiliated to Nantong University from January 2019 to March 2021 were selected and divided into group A, group B, and group C by random number table method, with 41 cases in each group. After induction of anesthesia, groups A and B were given esketamine 0.8 mg/kg and 0.6 mg/kg intravenously respectively (infusion completed within 15 minutes), while group C didn't use esketamine. The operation time, recovery time, extubation time, and 24 h cumulative morphine consumption were compared among the three groups. The hemodynamic indexes (heart rate, mean arterial pressure), pain stress indexes prostaglandin E2 (PEG2), substance P (SP), and visual pain simulation (VAS) scores were compared among the three groups at different times. Adverse reactions during hospitalization in the three groups were compared.Results There was no significant difference in the operation time, extubation time, and 24 h cumulative morphine consumption between groups A, B, and C (P > 0.05). The wake-up time of group A, group B, and group C was statistically different by variance analysis (P < 0.05). The wake-up time of group B was shorter than that of group A and group C. There were significant differences in heart rate, mean arterial pressure, time, and interaction between groups A, B, and C (P < 0.05). The heart rate and mean arterial pressure in the group were increased (P < 0.05). Compared with intraoperative, the heart rate, and mean arterial pressure of the three groups were decreased at 1 h after operation (P < 0.05). The heart rate and mean arterial pressure of group B during operation and 1 h after operation were lower than those of group A and group C (P < 0.05). There were statistically significant differences among the PEG2 and SP groups, time and interaction among the three groups of patients in group A, group B, and group C (P < 0.05). Compared with before operation, the levels of PEG2 and SP in the three groups were increased during operation and 1 h after operation (P < 0.05). Compared with intraoperative, PEG2 and SP of the three groups increased at 1 h after operation (P < 0.05). There was no significant difference in preoperative PEG2 and SP between groups A, B and C (P > 0.05). The levels of PEG2 and SP in group A and group B during operation and 1 h after operation were lower than those in group C (P < 0.05). There was no significant difference in PEG2 and SP between group A and group B during operation and 1 h after operation (P > 0.05). There were statistically significant differences in VAS score, time and interaction among groups A, B and C (P < 0.05). Compared with 2 hours after operation, the VAS scores of the three groups were decreased at 6 hours and 12 hours after operation (P < 0.05). Compared with 6 hours after operation, the VAS scores of the three groups were decreased at 12 hours after operation (P < 0.05). There was no significant difference in VAS scores between groups A, B and C at 2 h after operation (P > 0.05). The VAS scores of group A and group B at 6 hours and 12 hours after operation were lower than those in group C (P < 0.05). There was no significant difference in VAS scores between group A and group B at 6 hours and 12 hours after operation (P > 0.05). There was no significant difference in the incidence of total adverse reactions among the three groups (P > 0.05).Conclusion 0.6 mg/kg and 0.8 mg/kg esketamine can effectively prevent remifentanil-induced hyperalgesia and reduce pain in patients undergoing laparoscopic resection of benign ovarian tumors. However, the dose of 0.6 mg/kg is prior to the 0.8 mg/kg dose in terms of shortening recovery time and stabilizing hemodynamics.