艾司氯胺酮联合舒芬太尼对腹腔镜结肠癌根治术后镇痛效果及血流动力学的影响

Effects of esketamine combined with sufentanil on analgesia and hemodynamics after laparoscopic radical resection of colon cancer

摘要:

目的 探讨艾司氯胺酮联合舒芬太尼对腹腔镜结肠癌根治术后镇痛效果及血流动力学的影响。方法 选取2020年6月—2022年1月在三亚中心医院行腹腔镜结肠癌根治术的104例患者为研究对象，并随机分为对照组和研究组，每组52例。对照组术后镇痛给予舒芬太尼，研究组术后镇痛给予艾司氯胺酮联合舒芬太尼。比较两组患者术后镇痛相关指标。比较两组患者视觉模拟评分（VAS）、血流动力学指标、疼痛应激指标及理查兹-坎贝尔睡眠量表（RCSQ）评分的变化。比较两组药物相关不良反应发生情况。结果 研究组舒芬太尼用量、镇痛泵有效按压次数少于对照组（P <0.05）。对照组与研究组T₁、T₂、T₃、T₄、T₅时VAS评分、收缩压（SBP）、舒张压（DBP）、心率（HR）及平均动脉压（MAP）比较，经重复测量设计的方差分析，结果 ①不同时间点VAS评分、SBP、DBP、HR及MAP有差异（F= 8.257、6.814、8.679、7.035和6.548，均P =0.000）；②两组VAS评分、SBP、DBP、HR及MAP有差异（F =8.009、7.512、9.184、8.135和7.006，均P =0.000）；③研究组与对照组VAS评分、SBP、DBP、HR及MAP变化趋势有差异（F =7.536、7.039、8.249、7.854和6.438，均P =0.000）。对照组与研究组T₁、T₃、T₅时ACTH、Cor比较，经重复测量设计的方差分析，结果 ①不同时间点ACTH、Cor有差异（F =9.186和8.256，均P =0.000）；②两组ACTH、Cor有差异（F =8.743和7.654，均P =0.000）；③对照组与研究组ACTH、Cor变化趋势有差异（F =7.183和7.886，均P =0.000）。对照组与研究组术前1 d、术后1 d、术后2 d的RCSQ评分比较，经重复测量设计的方差分析，结果 ①不同时间点RCSQ评分有差异（F =8.415，P= 0.000）；②研究组与对照组RCSQ评分有差异（F= 7.302，P =0.000）；③对照组与研究组RCSQ评分变化趋势有差异（F =6.854，P =0.000）。两组总不良反应发生率比较，差异无统计学意义（P >0.05）。结论 艾司氯胺酮联合舒芬太尼用于腹腔镜结肠癌根治术可提高术后镇痛效果，稳定血流动力学指标，抑制术后应激反应，改善睡眠状况，且安全性良好。

Abstract:

Objective To investigate the effects of esketamine combined with sufentanil on analgesia and hemodynamics after laparoscopic radical resection of colon cancer.Methods A total of 104 patients who underwent laparoscopic radical resection of colon cancer in our hospital from June 2020 to January 2022 were selected and randomly divided into the control group and the study group, with 52 cases in each group. The control group was given sufentanil, and the study group was given esketamine combined with sufentanil for postoperative analgesia. The analgesia-related indicators after surgery were compared between the two groups. The Visual Analogue Scale (VAS) scores, hemodynamic indicators, serum indicators of stress response to pain, and Richards-Campbell Sleep Questionnaire (RCSQ) scores at different time points were compared between the two groups of patients. The incidence of drug-related adverse reactions in the two groups was compared.Results The dosage of sufentanil was lower and the effective use of analgesic pump was less in the study group compared with the control group (P < 0.05). The VAS scores, systolic blood pressure (SBP), diastolic blood pressure (DBP), heart rate (HR) and mean arterial pressure (MAP) at T₁, T₂, T₃, T₄, T₅ in the control group were compared with those in the study group via repeated measures ANOVA. The results revealed that VAS scores, SBP, DBP, HR and MAP were different among the time points (F = 8.257, 6.814, 8.679, 7.035 and 6.548, all P = 0.000) and between the two groups (F = 8.009, 7.512, 9.184, 8.135 and 7.006, all P = 0.000), and that the change trends of VAS scores, SBP, DBP, HR and MAP were also different between the two groups (F = 8.009, 7.512, 9.184, 8.135 and 7.006, all P = 0.000). The levels of ACTH and Cor at T₁, T₃ and T₅ were compared between the control group and the study group. The results of repeated measures ANOVA showed that there were differences in levels of ACTH and Cor at different times (F = 9.186 and 8.256, all P = 0.000) and between the two groups (F = 8.743 and 7.654, all P = 0.000), and that the change trends of levels of ACTH and Cor were different between the study group and the control group (F = 7.183 and 7.886, all P = 0.000). The RCSQ scores at 1 day before operation, 1 day after operation, and 2 days after operation in the control group and the study group were compared via repeated measures ANOVA, and the results demonstrated that the RCSQ scores were different among the time points (F = 8.415, P = 0.000) and between the control group and the study group (F= 7.302, P = 0.000), and that the change trends of RCSQ scores were different between the two groups (F = 6.854, P = 0.000). There was no significant difference in the overall incidence of adverse drug reactions between the two groups (P >0.05).Conclusions Esketamine combined with sufentanil for laparoscopic radical colon cancer surgery may enhance postoperative analgesia, stabilize hemodynamic indicators, inhibit postoperative stress responses, and improve sleep quality, with few safety concerns.