艾司氯胺酮全程镇痛在糖尿病足截肢患者中的应用效果

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Abstract Objective To observe the application effects of whole-course analgesia with Esketamine on patients with diabetic foot amputation. Methods Forty patients undergoing diabetic foot amputation in Shangrao People′s Hospital from June 2020 to September 2021 were selected as the research subjects, and were divided into experimental group (n=20)and blank group (n=20) according to random number table method. The trial group was given 0.1 μg/kg of Esketamine for analgesia before anesthesia, and then given Midazolam, Esketamine, Propofol, and Rocuronium Bromide for anesthesia induction, while the blank group was not given analgesia treatment before anesthesia and adopted Midazolam, Fentanyl, Propofol and Rocuronium Bromide for anesthesia induction. After surgery, the experimental group received patient-controlled analgesia pump with Esketamine and Dexmedetomidine, and the blank group received Fentanyl and Dexmedetomidine connected to patient-controlled analgesia pump. Serum C-reactive protein (CRP), cortisol (Cor), interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α), γinterferon (IFN-γ), CD3+, CD4+and CD8+at 15 min before anesthesia (T0), at 24 h after surgery (T1) and at 48 h after surgery (T2), the number of effective analgesia pump compressions at T1 and T2, visual analogue scale (VAS)score, postoperative adverse reactions, scores of short-form McGill pain questionnaire (SF-MPQ) and Hamilton anxiety scale (HAMA) and incidence rate of phantom limb pain at 6 weeks after surgery and satisfaction at 3 months after surgery were compared between the two groups of patients. Results There were no significant differences in CRP, Cor,IL-6, TNF-α and IFN-γ between two groups at T0 (P＞0.05). At T1 and T2, CRP, Cor, IL-6, TNF-α and IFN-γ in the experimental group were lower than those in the control group, with statistical significance (P＜0.05). There were no significant differences in CD3+, CD4+and CD8+between two groups at T0 (P＞0.05). At T1 and T2, CD8+in the experimental group was lower than that in the blank group, while CD3+ and CD4+ were higher than those in the blank group, with statistical significance (P＜0.05). The VAS score of T1 and T2 in the experimental group was lower than that in the blank group, and the number of effective analgesic pump pressing was less than that in the blank group, with statistical significance (P＜0.05). The incidence of adverse reactions in experimental group was lower than that in blank group, and the difference was statistically significant (P＜0.05). PRI, VAS, PPI and HAMA in the experimental group were lower than those in the blank group, and the incidence of postoperative phantom limb pain in the experimental group was lower than that in the blank group, with statistical significance (P＜0.05). The satisfaction of the experimental group was higher than that of the blank group 3 months after operation, and the difference was statistically significant (P＜0.05). Conclusion The application of Esketamine for whole-course analgesia in patients with diabetic foot amputation can relieve the postoperative stress and immunosuppression, and can significantly reduce the risk of postoperative phantom limb pain through effective analgesia. And the regimen has good safety and is favorable for prognosis and rehabilitation.

Key words： Esketamine Analgesia Diabetic foot Amputation Phantom limb pain

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	Articles by authors
	MAO Haifei
	MEI Kaibo
	WANG Qiming
	LIU Fanglan

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MAO Haifei,MEI Kaibo,WANG Qiming, et al. Application effect of whole-course analgesia with Esketamine on patients with amputation of diabetic foot[J]. 中国当代医药, 2022, 29(16): 65-69.

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https://www.dangdaiyiyao.com/EN/ OR https://www.dangdaiyiyao.com/EN/Y2022/V29/I16/65

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