不同剂量艾司氯胺酮对胸腔镜下肺手术患者镇痛效果的影响  

The effects of different doses of Esketamine on analgesia in patients undergoing thoracoscopic lung surgery

作　　者：樊珍 马艳辉[1] 贾怡童 刘淼[1] 王政 王天龙[1] FAN Zhen;MA Yanhui;JIA Yitong;LIU Miao;WANG Zheng;WANG Tianlong(Department of Anesthesiology,Xuanwu Hospital,Capital Medical University,Beijing 100053,China)

机构地区：[1]首都医科大学宣武医院麻醉科,100053

出　　处：《心肺血管病杂志》2022年第5期532-536,共5页Journal of Cardiovascular and Pulmonary Diseases

基　　金：北京市医院管理局临床医学发展专项经费(ZYLX201818)。

摘　　要：目的:探讨不同剂量艾司氯胺酮(Esketamine)用于胸腔镜下肺手术患者镇痛效果的研究。方法:选择2021年7月至2021年12月,就诊于首都医科大学宣武医院拟行胸腔镜下肺手术的患者75例,采用随机数字表法将患者分为对照组(C组)、低剂量艾司氯胺酮组(L组)和艾司氯胺酮组(E组),每组25例。L组和E组患者切皮前分别静脉注射等容量的艾司氯胺酮0.25 mg/kg和0.5mg/kg,C组患者静脉注射等容量0.9%氯化钠溶液。观察并比较三组患者给药前及给药后1min、2min、3min、5min、10min、15min、30min的收缩压、舒张压、平均动脉压和心率;记录患者术前、术毕即刻、术后30min、1h、6h、12h、24h静息及咳嗽时疼痛数字评分(NRS)、镇静评分(RASS)、术后镇痛药使用情况以及不良反应发生情况、患者恢复情况。结果:三组患者术后30min、1h、6h、12h咳嗽时NRS及术后30min、1h、6h静息时NRS评分均差异有统计意义(P<0.05);其中L组患者术后30min、1h、12h咳嗽时NRS及1h、6h静息时NRS评分均低于C组,差异有统计学意义(P<0.05);而E组患者则在30min、1h、6h、12h咳嗽时NRS及术后1h、6h静息时NRS评分均低于C组,差异有统计学意义(P<0.05)。但三组不同时点RASS评分均差异无统计学意义(P>0.05)。E组同C组相比,12h舒芬太尼的使用量明显减少(P<0.05),但L组与C组相比,舒芬太尼使用未见明显减少,且各组患者24h舒芬太尼用量也差异无统计学意义(P>0.05)。三组患者不同时间点血流动力学、术后不良反应发生率比较差异均无统计学意义(P>0.05)。结论:不同剂量的艾司氯胺酮用于胸腔镜下肺手术患者,可降低患者术后早期疼痛程度,减少镇痛药物的应用。Objective:To investigate the analgesic effect of different doses of Esketamine in patients undergoing thoracoscopic lung surgery.Methods:Seventy-five patients who underwent elective thoracoscopic assisted thoracic surgery in our hospital from July 2021 to December 2021 were selected and randomly divided into control group(group C),low-dose esketamine group(group L)and esketamine group(group E),with 25 patients in each group.Patients in group L and group E were intravenously injected with 0.25 mg/kg and 0.5 mg/kg esketamine before skin resection,and patients in group C were given the same amount of placebo-normal saline.Systolic blood pressure,diastolic blood pressure,mean arterial pressure and heart rate were observed and compared among the three groups at each point.NRS scores at rest and during mobilization,postoperative analgesic drug use,postoperative adverse reactions and recovery of the three groups were recorded before surgery,immediately after surgery,30min,1h,6h,12h and 24h after surgery.Results:There were statistically significant differences in NRS scores among the three groups at 30min,1h,6h and 12h postoperatively and at rest at 30min,1h and 6h postoperatively.NRS scores of patients in L group were lower than those in C group at 30min,1h and 12h postoperatively and at 1h and 6h at rest,with statistically significant differences(P<0.05);The NRS scores of patients in group E were lower than those in group C at 30min,1h,6h and 12h cough and at 1h and 6h postoperatively at rest,with statistically significant differences(P<0.05).However,there was no statistical difference in RASS scores among the three groups at different time points(P>0.05).Compared with group C,the consumption of sufentanil at 12 hours was significantly decreased in group E(P<0.05),but there was no significantly decreased in group L.And there was no statistical difference in the consumption of sufentanil at 24h among all groups(P<0.05).There were no significant differences in hemodynamics at different time points,incidence of postoperat

关 键 词：艾司氯胺酮 胸腔镜手术 镇痛 血流动力学 

分 类 号：R54[医药卫生—心血管疾病]