广西医学

目的探讨亚麻醉剂量的艾司氯胺酮在烧伤患者植皮术后镇痛中的应用效果。方法将60例择期行植皮术的烧伤患者随机分为观察组和对照组，每组30例。对照组患者采用常规麻醉方法，观察组患者在常规麻醉过程及术后镇痛中加用亚麻醉剂量的艾司氯胺酮。比较两组患者的术中情况、麻醉药物用量、麻醉苏醒情况，术后2 h、6 h、12 h、24 h、48 h在静息状态和运动状态下的疼痛数字评定量表（NRS）评分，术后48 h 内按压镇痛泵次数、行补救镇痛情况和不良反应发生情况，术前1 d、术后1 d和术后1个月的40项恢复质量量表（QoR-40）评分。结果两组患者的术中情况、麻醉药物用量及麻醉复苏情况比较，差异均无统计学意义（均P＞0.05）。术后48 h内，观察组患者在静息状态和运动状态下的疼痛NRS评分呈下降趋势且低于对照组，患者按压镇痛泵次数及行补救镇痛的患者例数也少于对照组（均P＜0.05）。两组患者恶心/呕吐、头晕/嗜睡、幻觉/噩梦发生率差异均无统计学意义（均P＞0.05）。观察组患者的QoR-40总分及各维度得分总体呈增加趋势，且观察组术后1 d和术后1个月的情绪状态维度得分、心理支持维度得分、疼痛维度得分、QoR-40总分，以及术后1个月身体舒适度维度得分均高于对照组（均P＜0.05)。结论亚麻醉剂量的艾司氯胺酮能减轻烧伤患者植皮术后疼痛，且可提高患者的术后恢复质量。

ObjectiveTo investigate the application effect of subanesthetic dose of esketamine in analgesia of burn patients after dermatoplasty. MethodsSixty burn patients who underwent elective dermatoplasty were randomly divided into observation group or control group, with 30 cases in each group. The control group received routine anesthetic method, and the observation group additionally received subanesthetic dose of esketamine during routine anesthesia and postoperative analgesia. The intraoperative status, dosage of anesthetic drugs, recovery from anesthesia, the Numerical Rating Scale (NRS) score for pain in resting and exercise states after 2, 6, 12, 24, and 48 hours of operation, frequency of pressing analgesic pump, state of undergoing remedial analgesia, occurrence of adverse reactions within 48 hours of operation, and the 40-Item Quality of Recovery Scale (QoR-40) score 1 day before operation, 1 day after operation, and 1 month after operation were compared between patients of the two groups. ResultsNo statistically significant difference in intraoperative status, dosage of anesthetic drugs, and recovery from anesthesia was found between the two groups (all P＞0.05). Within 48 hours after operation, the NRS score for pain in resting and exercise states of the observation group depicted a downward trend, and was lower than that of the control group; besides, the frequency of patients pressing analgesic pump and number of patients undergoing remedial analgesia of the observation group were also less than those of the control group (all P＜0.05). There was no statistically significant difference in the incidence rates of nausea/vomiting, dizziness/drowsiness, hallucination/nightmare between the two groups (all P＞0.05). The total score and scores of various dimensions of QoR-40 in the observation group interpreted an overall upward trend, and the observation group yielded higher scores of emotional state dimension, psychological support dimension, pain dimension, and a higher total score of QoR-40 1 day and 1month after operation, as well as a higher score of physical comfort dimension 1 month after operation as compared with the control group (all P＜0.05). ConclusionSubanesthetic dose of esketamine can alleviate postoperative pain of burn patients after dermatoplasty, and improve quality of postoperative recovery in patients.