2025 年第 4 期 第 20 卷

艾司氯胺酮复合舒芬太尼在肝癌切除术患者中的有效性及安全性分析

Efficacy and safety analysis of esketamine combined with sufentanil in patients undergoing liver cancer resection

作者：周瑞欣王洪涛王振云张津广庞玉池

英文作者：Zhou Ruixin Wang Hongtao Wang Zhenyun Zhang Jinguang Pang Yuchi

单位：河北省沧州中西医结合医院麻醉科，沧州061000

英文单位：Department of Anesthesiology Cangzhou Hospital of Integrated Traditional Chinese and Western Medicine Hebei Province Cangzhou 061000 China

关键词：肝癌切除术；艾司氯胺酮；舒芬太尼

英文关键词：Livercancerresection;Esketamine;Sufentanil

• 摘要：

• 目的 探讨艾司氯胺酮复合舒芬太尼在肝癌切除术患者中的有效性及安全性。方法 按简单随机法将2021年11月至2023年11月于河北省沧州中西医结合医院行肝癌切除术的108例原发性肝癌患者分为舒芬太尼组和联合组，各54例。2组患者术后均采用静脉自控镇痛（PCIA），舒芬太尼组接受舒芬太尼与昂丹司琼治疗；联合组在舒芬太尼组的基础上联合艾司氯胺酮治疗。比较2组围手术期指标，术后6、24、48 h视觉模拟量表（VAS）评分、呼吸循环功能指标。记录不良反应发生情况。结果 联合组首次下床时间、PCIA药物使用剂量短于/低于舒芬太尼组［（33±4）h比（39±4）h、（56±5）ml比（79±6）ml］（均P＜0.001）。术后6、24、48 h 2组VAS评分均呈降低趋势，且联合组各时点VAS评分均低于对照组（均P＜0.001）；2组平均动脉压、心率水平呈降低趋势且联合组各时点均低于对照组（均P＜0.001）；联合组各时点脉搏血氧饱和度水平均高于舒芬太尼组（均P＜0.05）。联合组不良反应发生率低于舒芬太尼组（P＜0.05）。结论 艾司氯胺酮复合舒芬太尼PCIA应用于肝癌切除术患者镇痛效果确切，可改善围手术期指标，且对患者的呼吸循环功能影响较小，安全性高。

• Objective To investigate the efficacy and safety of esketamine combined with sufentanil in patients undergoing liver cancer resection. Methods A total of 108 patients with primary liver cancer who underwent liver cancer resection in Cangzhou Hospital of Integrated Traditional Chinese and Western Medicine, Hebei Province from November 2021 to November 2023 were divided into sufentanil group and combination group by simple random method, with 54 cases in each group. Patients in both groups were treated with patient-controlled intravenous analgesia (PCIA) after operation. The sufentanil group was treated with sufentanil and ondansetron. The combination group was treated with esketamine on the basis of sufentanil group. The perioperative indexes, visual analogue scale (VAS) scores, respiratory and circulatory function indexes at 6, 24 and 48 hours after operation were compared between the two groups. The occurrence of adverse reactions was recorded. Results The first ambulation time and the dosage of PCIA in the combined group were shorter/lower than those in the sufentanil group ［(33±4)h vs (39±4)h, (56±5)ml vs (79±6)ml］(both P<0.001). The VAS scores of the two groups showed a decreasing trend at 6, 24 and 48 hours after operation, and the VAS scores of the combined group were lower than those of the control group at each time point (all P<0.001). The mean arterial pressure and heart rate of the two groups showed a decreasing trend, and the levels of the combined group were lower than those of the control group at each time point (all P<0.001). The pulse oxygen saturation of the combined group was higher than that of the sufentanil group at each time point (all P<0.05). The incidence of adverse reactions in the combined group was lower than that in the sufentanil group (P<0.05). Conclusion PCIA with esketamine combined with sufentanil has definite analgesic effect in patients undergoing liver cancer resection, can improve perioperative indicators, and has little effect on respiratory and circulatory function of patients, with high safety.