混合痔术后静脉自控镇痛中应用艾司氯胺酮与布托啡诺复合舒芬太尼的效果对比

Comparison of efficacy of esketamine versus butorphanol combined with sufentanil in patient-controlled intravenous analgesia after mixed hemorrhoids surgery

摘要:

目的 探讨混合痔术后静脉自控镇痛（PCIA）中应用艾司氯胺酮与布托啡诺复合舒芬太尼的效果。方法 选取2021年6月—2022年7月阜阳市人民医院收治的74例混合痔切除术患者，按随机数字表法分为对照组和观察组，各37例。对照组术后采用布托啡诺复合舒芬太尼进行PCIA，观察组术后采用艾司氯胺酮复合舒芬太尼进行PCIA。比较两组患者术后不同时间点的镇痛效果［视觉模拟评分法（VAS）］、认知功能［蒙特利尔认知评估（MoCA）量表］，检测血清应激指标水平［促肾上腺皮质激素（ACTH）、皮质醇（COR）］，记录患者PCIA首次按压时间及首次排便VAS评分，统计术后48 h内舒芬太尼用量，PCIA按压次数，并观察镇痛药物的安全性。结果 观察组与对照组麻醉前、麻醉后5和15 min的心率（HR）、血氧饱和度（SpO₂）比较，结果 ①不同时间点HR、SpO₂比较，差异均有统计学意义（P <0.05）；②观察组与对照组HR、SpO₂比较，差异均无统计学意义（P >0.05）；③两组HR、SpO₂变化趋势比较，差异均无统计学意义（P >0.05）。观察组与对照组术后2、4、24和48 h的VAS评分比较，结果 ①不同时间点VAS评分比较，差异有统计学意义（P <0.05）；②观察组与对照组VAS评分比较，差异有统计学意义（P <0.05），观察组VAS评分较低，相对镇痛效果较好；③两组VAS评分变化趋势比较，差异有统计学意义（P <0.05）。观察组术后48 h与术前ACTH、COR的差值均低于对照组（P <0.05）。观察组与对照组术后1个月与术前MoCA评分的差值比较，差异无统计学意义（P >0.05）。观察组术后48 h舒芬太尼总剂量、首次排便VAS评分、PCIA按压次数均低于对照组（P <0.05），PCIA首次按压时间长于对照组（P <0.05）。观察组与对照组的不良反应总发生率分别为21.62%和24.32%，差异无统计学意义（P >0.05）。结论 与布托啡诺复合舒芬太尼比较，艾司氯胺酮复合舒芬太尼能够提高混合痔术后PCIA的镇痛效果，避免认知功能损伤，同时减少舒芬太尼用量及PCIA按压次数，未增加不良反应的发生。

Abstract:

Objective To compare the efficacy of esketamine versus butorphanol combined with sufentanil in patient-controlled intravenous analgesia (PCIA) after mixed hemorrhoids surgery.Methods Seventy-four patients undergoing mixed hemorrhoids resection at Fuyang People's Hospital from June 2021 to July 2022 were selected, and were divided into the control group and the observation group by the random number table method, with 37 patients in each group. The control group was treated with butorphanol combined with sufentanil for PCIA after operation, and the observation group was treated with esketamine combined with sufentanil for PCIA after operation. The analgesic effect [Visual Analogue Scale (VAS) ] and cognitive function [Montreal Cognitive Assessment (MoCA) scale] of the two groups of patients at different times after surgery were compared. The serum levels of stress indicators [adrenocorticotropic hormone (ACTH) and cortisol (COR) ] were detected, the first pressing time of PCIA and the VAS score for the first defecation were recorded, the amount of sufentanil and the number of PCIA press within 48 hours after surgery were counted, and the safety of analgesic drugs was observed.Results The HR and SpO₂ of the observation group and the control group before anesthesia, and 5 min and 15 min after anesthesia were compared, which exhibited that they were different among the time points (P < 0.05) but not between the groups (P > 0.05), and that there was no significant difference in the change trends of HR and SpO₂ between the two groups (P > 0.05). The VAS scores of the observation group and the control group at 2 h, 4 h, 24 h and 48 h after operation were compared, which demonstrated that they were different among the time points (P < 0.05) and between the groups (P < 0.05), where the observation group had a lower VAS score indicative of a better analgesic effect. Besides, there was a significant difference in the change trend of VAS scores between the two groups (P < 0.05). The differences of ACTH and COR levels before and 48 hours after operation in the observation group were lower than those in the control group (P < 0.05). There was no significant difference in the difference of MoCA scores before and 1 month after operation between the observation group and the control group (P > 0.05). There were statistically significant differences in the total dose of sufentanil, the first pressing time of PCIA, the VAS score for the first defecation and the number of PCIA press between the observation group and the control group (P < 0.05). The VAS score for the first defecation, the number of PCIA press and the total dose of sufentanil within 48 hours after operation in the observation group were lower than those in the control group (P < 0.05), and the first pressing time of PCIA in the observation group was longer than that in the control group (P < 0.05). The overall incidence of adverse reactions of the observation group and the control group were 21.62% and 24.32%, respectively, with no significant difference between the two groups (P > 0.05).Conclusions Compared with butorphanol combined with sufentanil, esketamine combined with sufentanil can improve the analgesic effect of PCIA after mixed hemorrhoids surgery, avoid cognitive impairment, and reduce the dose of sufentanil and the number of PCIA presses, without increasing the occurrence of adverse reactions.