不同剂量艾司氯胺酮联合舒芬太尼在全子宫切除患者术后静脉镇痛中的应用
The Application of Different Doses of Esketamine Combined with Sufentanil in Postoperative Intravenous Analgesia for Patients Undergoing Total Hysterectomy

目的：探讨艾司氯胺酮联合舒芬太尼在腹腔镜子宫全切术后静脉自控镇痛(PCIA)中的应用效果及最佳配伍。方法：纳入本院100名择期行腹腔镜全子宫切除术的患者，随机分为四组，均接受患者自控静脉镇痛(PCIA)。对照组(N组)使用舒芬太尼3.0 μg/kg + 甲氧氯普胺20 mg，用生理盐水稀释至100 ml；研究组分别给予艾司氯胺酮0.25 mg/kg (A1组)、0.5 mg/kg (A2组)、1.0 mg/kg (A3组)，联合舒芬太尼2.0 μg/kg + 甲氧氯普胺20 mg，用生理盐水稀释至100 ml。在术后2、6、12、24和48小时记录患者VAS、Ramsay镇静评分及PCIA按压次数，同时记录术后48小时内不良反应和术后第3天QoR-15评分。结果：与N组和A1组相比，A2和A3组术后6 h~48 h的VAS评分、恶心呕吐发生率、补救镇痛率及6~48 h总PCIA有效按压次数均降低，术后第3天QoR-15评分较高(P < 0.0083)，A2组术后6 h和A3组术后2 h、6 h Ramsay评分降低(P < 0.0083)。A3组术后24 h、48 h的VAS评分较A2组降低(P < 0.0083)。结论：1.0 mg/kg艾司氯胺酮联合2.0 μg/kg舒芬太尼的PCIA方案在腹腔镜全子宫切除患者术后的疼痛管理有更明显的优势，同时早期恢复质量方面较高、不良反应的发生率显著降低。
Objective: To evaluate the efficacy and optimal combination of esketamine combined with sufentanil in patient-controlled intravenous analgesia (PCIA) after laparoscopic total hysterectomy. Methods: A total of 100 patients scheduled for elective laparoscopic total hysterectomy in our hospital were enrolled and randomly divided into four groups, all of whom received PCIA. The control group (Group N) received sufentanil 3.0 μg/kg + metoclopramide 20 mg, which diluted to 100 ml with normal saline. The study groups respectively received esketamineat doses of 0.25 mg/kg (Group A1), 0.5 mg/kg (Group A2), and 1.0 mg/kg (Group A3), combined with sufentanil 2.0 μg/kg + metoclopramide 20 mg, which diluted to 100 ml with normal saline. VAS, Ramsay sedation scores, and PCIA press counts were recorded at 2, 6, 12, 24, and 48 hours postoperatively. Additionally, adverse events within the first 48 hours and QoR-15 scores on postoperative day 3 were documented. Results: Compared with the N and A1 groups, patients in the A2 and A3 groups showed significantly better postoperative outcomes, including lower VAS scores, reduced nausea and vomiting, fewer rescue analgesia needs, and fewer PCIA button presses during the 6~48-hour postoperative period. QoR-15 scores on postoperative day 3 were also higher (P < 0.0083). Additionally, Ramsay sedation scores were lower at 6 hours in the A2 group and at 2 and 6 hours in the A3 group (P < 0.0083). Notably, VAS scores at 24 and 48 hours were significantly lower in the A3 group compared with the A2 group (P < 0.0083). Conclusion: The PCIA regimen of 1.0 mg/kg esketamine combined with 2.0 μg/kg sufentanil demonstrates superior efficacy in postoperative pain management for patients undergoing laparoscopic total hysterectomy, with improved early