艾司氯胺酮复合麻醉对肺癌根治术患者术后心理痛苦的影响  

Effect of esketamine-based anesthesia on postoperative psychological distress in patients undergoing radical resection of lung cancer

作　　者：王佳[1] 李岩 Wang Jia;Li Yan(Department of Anesthesiology,Shanxi Provincial People′s Hospital,Taiyuan 030012,China;Department of Anesthesiology,Tianjin Jizhou District People′s Hospital,Tianjin 301900,China)

机构地区：[1]山西省人民医院麻醉科,太原030012 [2]天津市蓟州区人民医院麻醉科,天津301900

出　　处：《中华麻醉学杂志》2022年第3期312-315,共4页Chinese Journal of Anesthesiology

基　　金：中国博士后科学基金面上资助项目(2019M650769)。

摘　　要：目的评价艾司氯胺酮复合麻醉对肺癌根治术患者术后心理痛苦的影响。方法2019年12月至2020年11月在本院行肺癌根治术患者121例,性别不限,年龄18~75岁,BMI 18.5~24.9 kg/m^(2),ASA分级Ⅰ~Ⅲ级。采用随机数字表法分为2组:对照组(C组,n=60)和艾司氯胺酮复合麻醉组(EK组,n=61)。2组均采用静吸复合麻醉。EK组切皮前静脉注射艾司氯胺酮0.5 mg/kg,术中持续静脉泵注速率0.5 mg·kg^(-1)·h^(-1),手术结束前30 min停药。EK组术后镇痛持续静脉泵注艾司氯胺酮速率为0.2 mg·kg^(-1)·h^(-1),持续48 h。2组术后镇痛均采用舒芬太尼100μg+酮咯酸氨丁三醇120 mg+氟哌利多2.5 mg共100 ml,背景剂量2 ml/h,单次按压2 ml,锁定时间15 min。于术后7 d及1个月采用心理痛苦温度计对患者进行评估,刻度≥4为心理痛苦,记录患者疼痛的发生情况,记录术后3 d内不良反应的发生情况。结果与C组比较,EK组术后7 d和1个月患者心理痛苦发生率和疼痛发生率降低(P<0.05)。2组患者术后3 d内不良反应发生率比较差异无统计学意义(P>0.05)。结论艾司氯胺酮复合麻醉可降低肺癌根治术患者术后心理痛苦的发生。Objective To evaluate the effect of esketamine-based anesthesia on postoperative psychological distress in the patients undergoing radical resection of lung cancer.Methods From December 2019 to November 2020,121 patients(male or female),aged 18-75 yr,with body mass index of 18.5-24.9 kg/m^(2),of American Society of Anesthesiologists physical statusⅠ-Ⅲ,underwent radical resection of lung cancer in our hospital,were divided into 2 groups by a random number table method:control group(group C,n=60)and esketamine combined anesthesia group(group EK,n=61).Combined intravenous-inhalational anesthesia was used in both groups.In EK group,esketamine 0.5 mg/kg was intravenously injected before skin incision,and esketamine was continuously infused at a rate of 0.5 mg·kg^(-1)·h^(-1) during surgery and then adiministration was discontinued at 30 min before the end of surgery.In EK group,esketamine was continuously infused at a rate of 0.2 mg·kg^(-1)·h^(-1) for postoperative analgesia,lasting for 48 h.Postoperative analgesia was performed with sufentanil 100μg+ketorolac tromethamine 120 mg+droperidol 2.5 mg(100 ml in total)in both groups,with background infusion 2 ml/h,bolus dose 2 ml and lockout interval 15 min.The patients were assessed using a psychological distress thermometer at 7 days and 1 month after surgery,and distress thermometer≥4 was defined as psychological distress.The occurrence of pain was recorded,and the occurrence of adverse reactions within 3 days after surgery was recorded.Results Compared with group C,the incidence of psychological distress was significantly decreased at 7 days and 1 month after operation in group EK(P<0.05).There was no significant difference in the incidence of adverse reactions within 3 days after operation between the two groups(P>0.05).Conclusions Esketamine-based anesthesia can decease the occurrence of psychological distress after radical resection of lung cancer in the patients.

关 键 词：氯胺酮 肺肿瘤 心理痛苦 

分 类 号：R614[医药卫生—麻醉学] R734.2[医药卫生—外科学]