2021 年第 7 期 第 16 卷

小剂量氯胺酮联合瑞芬太尼麻醉对 子宫肌瘤剔除术患者血流动力学及疼痛介质水平的影响

Effects of low-dose ketamine combined with remifentanil anesthesia on hemodynamics and pain medium level in patients undergoing myomectomy

作者：朱荣誉朱贤林吴述轩

英文作者：Zhu Rongyu Zhu Xianlin Wu Shuxuan

单位：湖北省恩施土家族苗族自治州中心医院麻醉科445000

英文单位：Department of Anesthesiology the Central Hospital of Enshi Tujia and Miao Autonomous Prefecture Hubei Province Enshi 445000 China

关键词：子宫肌瘤剔除术；氯胺酮；瑞芬太尼；血流动力学；疼痛介质

英文关键词：Myomectomy;Ketamine;Remifentanil;Hemodynamics;Painmedium

• 摘要：

• 目的 探讨小剂量氯胺酮联合瑞芬太尼麻醉对子宫肌瘤剔除术患者血流动力学及疼痛介质水平的影响。方法 选取2019年1月至2020年7月在湖北省恩施土家族苗族自治州中心医院行腹腔镜子宫肌瘤剔除术患者98例，按照随机数字表法分为对照组（49例）和观察组（49例）。对照组采用瑞芬太尼复合丙泊酚常规麻醉诱导和维持，观察组在对照组基础上联合小剂量氯胺酮维持麻醉。比较2组不同时点的血流动力学参数、疼痛介质水平和视觉模拟量表（VAS）评分以及拔管时间、呼吸恢复时间、苏醒时间，观察不良反应发生情况。结果 观察组术后24 h的平均动脉压和心率均明显低于对照组，手术结束时、术后24 h的血清P物质、前列腺素E2及5-羟色胺水平均明显低于对照组（均P＜0.05）。观察组术后1、6、12、24 h的疼痛VAS评分均明显低于对照组［（3.1±0.9）分比（4.4±1.0）分、（2.9±0.8）分比（3.7±1.0）分、（1.7±0.7）分比（2.4±0.7）分、（1.0±0.6）分比（2.0±0.7）分］（均P＜0.001）。2组拔管时间、呼吸恢复时间及苏醒时间、不良反应发生率比较差异均无统计学意义（均P＞0.05）。结论 小剂量氯胺酮联合瑞芬太尼麻醉用于子宫肌瘤剔除术，能够稳定患者术后血压和心率，并抑制疼痛介质的分泌。

• Objective To investigate the effects of low-dose ketamine combined with remifentanil anesthesia on hemodynamics and pain medium level in patients undergoing myomectomy. Methods From January 2019 to July 2020, 98 cases of laparoscopic myomectomy in the Central Hospital of Enshi Tujia and Miao Autonomous Prefecture, Hubei Province were selected. They were randomly divided into control group (49 cases) and observation group (49 cases). The control group was given remifentanil combined with propofol conventional anesthesia induction and maintenance, and the observation group was combined with low-dose ketamine to maintain anesthesia on the basis of the control group. The hemodynamic parameters, pain medium level, visual analogue scale (VAS) score, extubation time, respiratory recovery time and awaking time were compared between the two groups at different time points. The occurrence of adverse reactions was observed. Results The mean arterial pressure and heart rate at 24 h after operation in the observation group were significantly lower than those in the control group, and at the end of operation and 24 h after operation, the levels of serum substance P, prostaglandin E2 and 5-hydroxytryptamine in the observation group were significantly lower than those in the control group (all P＜0.05). The pain VAS scores in the observation group at 1, 6, 12 and 24 h after operation were significantly lower than those in the control group［（3.1±0.9） vs （4.4±1.0）, （2.9±0.8） vs （3.7±1.0）, （1.7±0.7） vs （2.4±0.7）,（1.0±0.6） vs （2.0±0.7）］（all P＜0.001）. There were no significant differences in extubation time, respiratory recovery time, awaking time and incidence of adverse reactions between the two groups (all P＞0.05). Conclusion Low-dose ketamine combined with remifentanil anesthesia can stabilize the blood pressure and heart rate and inhibit the secretion of pain medium during myomectomy.