■这项研究评估了右美托咪定和艾氯胺酮联合输注对接受改良根治术的患者恢复质量的影响。
■共135例患者随机分为三组:右美托咪定组(D组)接受右美托咪定(0.5µg/kg负荷,0.4µg/kg/h输注),右美托咪定加低剂量艾氯胺酮组(DE1组)接受右美托咪定(0.5µg/kg负荷,0.4微克/千克/小时输注)和艾氯胺酮(0.5毫克/千克负荷,2µg/kg/min输注),右美托咪定加高剂量艾氯胺酮组(DE2组)接受右美托咪定(0.5µg/kg负荷,0.4微克/千克/小时输注)和艾氯胺酮(0.5毫克/千克负荷,4µg/kg/min输注)。主要结果是手术后1天的恢复质量-15(QoR-15)评分。次要终点是手术后3天的总QoR-15评分,异丙酚和瑞芬太尼的需求,苏醒和拔管时间,术后视觉模拟评分(VAS)疼痛评分,抢救镇痛药,恶心和呕吐,心动过缓,过度镇静,噩梦,和激动。
■术后3天,DE1和DE2组的总体QoR-15评分明显高于D1和D组(P<0.05)。术后6、12、24h的VAS疼痛评分,DE1组和DE2组的丙泊酚和瑞芬太尼需求量明显低于D组(P<0.05)。与D组相比,唤醒时间,拔管时间,DE1组和DE2组麻醉后监护病房(PACU)住院时间明显延长(P<0.05),DE2组明显长于DE1组(P<0.05)。D组术后抢救镇痛药和心动过缓的比例高于DE1和DE2组,过度镇静的发生率低于DE1和DE2组(P<0.05)。
■右美托咪定加艾氯胺酮部分改善了术后恢复质量,降低了心动过缓的发生率,但延长了苏醒时间,拔管时间,PACU留下来,尤其是右美托咪定加4µg/kg/min的艾氯胺酮。
UNASSIGNED: This study evaluated the effect of a combined infusion of dexmedetomidine and esketamine on the quality of recovery in patients undergoing modified radical mastectomy.
UNASSIGNED: A total of 135 patients were randomly divided into three groups: dexmedetomidine group (group D) received dexmedetomidine (0.5 µg/kg loading, 0.4 µg/kg/h infusion), dexmedetomidine plus low-dose esketamine group (group DE1) received dexmedetomidine (0.5 µg/kg loading, 0.4 µg/kg/h infusion) and esketamine (0.5 mg/kg loading, 2 µg/kg/min infusion), dexmedetomidine plus high-dose esketamine group (group DE2) received dexmedetomidine (0.5 µg/kg loading, 0.4 µg/kg/h infusion) and esketamine (0.5 mg/kg loading, 4 µg/kg/min infusion). The primary outcome was the overall quality of recovery-15 (QoR-15) scores at 1 day after surgery. The secondary endpoints were total QoR-15 scores at 3 days after surgery, propofol and remifentanil requirement, awaking and extubation time, postoperative visual analogue scale (VAS) pain scores, rescue analgesic, nausea and vomiting, bradycardia, excessive sedation, nightmares, and agitation.
UNASSIGNED: The overall QoR-15 scores were much higher in groups DE1 and DE2 than in groups D 1 and D 3 days after surgery (P < 0.05). VAS pain scores at 6, 12, 24 h postoperatively, propofol and remifentanil requirements were significantly lower in groups DE1 and DE2 than in group D (P < 0.05). Compared with group D, awaking time, extubation time, and post-anesthesia care unit (PACU) stay were significantly prolonged in groups DE1 and DE2 (P < 0.05) and were much longer in group DE2 than in group DE1 (P < 0.05). The proportion of postoperative rescue analgesics and bradycardia was higher and the incidence of excessive sedation was lower in group D than in groups DE1 and DE2 (P < 0.05).
UNASSIGNED: Dexmedetomidine plus esketamine partly improved postoperative recovery quality and decreased the incidence of bradycardia but prolonged awaking time, extubation time, and PACU stay, especially dexmedetomidine plus 4 µg/kg/min esketamine.