【罂粟摘要】基于艾司氯胺酮的少阿片药物麻醉在妇科日间手术中的研究：一项随机双盲对照试验

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基于艾司氯胺酮的少阿片药物麻醉在妇科日间手术中的研究：一项随机双盲对照试验

贵州医科大学  麻醉与心脏电生理课题组

翻译 ：宋雨婷

编辑 ：严旭

审校 ：曹莹

背景：

通过减少阿片类药物的相关副作用，少阿片药物麻醉的运用可以加快术后康复。本研究的目的是与传统麻醉相比，研究基于艾司氯胺酮的少阿片药物麻醉的可行性，观察妇科日间手术术后恶心呕吐（PONV）、术后疼痛、血流动力学等不良反应的发生情况。

方法：

本研究为一项前瞻性平行组随机对照试验。共纳入141名接受妇科日间手术的成年女性。患者被随机分为传统阿片类麻醉组（C组）、少阿片药物麻醉组（中度少阿片药物麻醉组（MO组）和低剂量阿片药物麻醉组（LO组））。三组术中用药如下，C组：麻醉诱导20μg/ kg阿芬太尼，麻醉维持40μg/kg/h的阿芬太尼；MO组：麻醉诱导20μg/ kg阿芬太尼，麻醉维持0.5 mg/kg/h艾司氯胺酮；LO组：麻醉诱导10μg/ kg阿芬太尼+0.2mg / kg艾司氯胺酮，麻醉维持0.5 mg/kg/h艾司氯胺酮。

结果：

三组患者的临床和手术数据比较如下。C组33.3%的患者、MO组18.4%的患者、LO组43.2%的患者均发生术后恶心（P =0.033），MO组术后24小时恶心发生率低于LO组（P <0.05）。三组患者拔管时间、术后平均住院时间、术后视觉模拟评分（VAS）无显著差异。血流动力学不良事件发生频率MO组 1（0，2）和LO组 0（0，1）显著降低（P < 0.05）。与C组相比，LO组麻醉后恢复室平均滞留时间（PACU）增加，为60.0 （36.25，88.75）和42.5 （25，73.75）（P <0.05）。

结论：

基于艾司氯胺酮的少阿片药物麻醉是可行的，可为患者提供有效的镇痛。艾司氯胺酮具有良好的镇痛作用，少阿片药物组显示出更为稳定的血流动力学。然而，较少使用或不使用阿片类药物术后舒适度较差。

原始文献来源：

Zhu T, Zhao X, Sun M, et al. Opioid-reduced anesthesia based on esketamine in gynecological day surgery: a randomized double-blind controlled study. BMC Anesthesiol. 2022;22(1):354.

英文原文：

Opioid-reduced anesthesia based on esketamine in gynecological day surgery a randomized double-blind controlled study

Abstract

Background Opioid-reduced anesthesia may accelerate postoperative rehabilitation by reducing opioid-related side effects. The objective was to investigate the feasibility of opioid-reduced general anesthesia based on esketamine and to observe postoperative nausea and vomiting (PONV), postoperative pain, hemodynamics and other adverse reactions in gynecological day surgery compared with the traditional opioid-based anesthesia program.

Method This study was conducted as a prospective parallel-group randomized controlled trial. A total of 141 adult women undergoing gynecological day surgery were included. Patients were randomly assigned to receive traditional opioid-based anesthesia (Group C) with alfentanil, or opioid-reduced anesthesia (a moderate-opioid group (Group MO) and low-opioid group (Group LO) with esketamine and alfentanil). For anesthesia induction, the three groups received 20, 20, 10 μgkg alfentanil respectively and Group LO received an additional 0.2 mgkg esketamine. For maintenance of anesthesia, the patients in Group C received 40 μgkgh alfentanil, and those in Group MO and Group LO received 0.5 mgkgh esketamine.

Results Patients in the three groups had comparable clinical and surgical data. A total of 33.3% of patients in Group C, 18.4% of patients in Group MO and 43.2% of patients in Group LO met the primary endpoint (p = 0.033), and the incidence of nausea within 24 hours after surgery in Group MO was lower than in Group LO (p  0.05). The extubation time, median length of stay in the hospital after surgery and visual analog scale (VAS) of postoperative pain were equivalent in the three groups. The frequencies of adverse hemodynamic events in the MO 1(0, 2) and LO 0(0, 1) groups were significantly decreased (p  0.05). Compared with Group C, the median length of stay in the postanesthesia care unit (PACU) in Group LO was increased, 60.0 (36.25, 88.75) vs. 42.5 (25, 73.75) minutes (p  0.05).

Conclusions Opioid-reduced anesthesia based on esketamine is feasible and provides effective analgesia for patients. Esketamine provided a positive analgesic effect and the opioid-reduced groups showed more stable hemodynamics. However, less or no use of opioids did not result in a more comfortable prognosis.

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