艾司氯胺酮用于胸腔镜下肺手术患者镇痛效果的研究  

Study on analgesic effect of esmketamine 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手术科,100053

出　　处：《心肺血管病杂志》2022年第6期657-661,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1月至2021年9月,就诊于首都医科大学宣武医院行择期胸腔镜下肺手术患者76例,采用随机数字表法将患者分为对照组(C组)和艾司氯胺酮组(E组),每组38例。E组切皮前静脉注射艾司氯胺酮0.5mg/kg,C组患者静脉注射等容量0.9%氯化钠溶液。观察并比较两组给药前及给药后1、2、3、5、10、15及30min的收缩压、舒张压、平均动脉压、心率及脑电双频谱指数(BIS);记录患者术前、术毕即刻、术后30min、1h、6h、12h、24h静息和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。结果:E组术后30min、1、6及12h咳嗽时NRS评分及术后1、6及12h静息时NRS评分均低于对照组,差异有统计学意义(P<0.05)。两组RASS评分比较差异无统计学意义(P>0.05)。E组与C组术后12h内舒芬太尼用量分别为(13.33±3.71)μg、(18.16±6.11)μg,E组用量明显低于C组(P<0.05)。E组与C组术后第二个12h舒芬太尼用量分别为(10.77±3.88)μg、(12.38±4.33)μg,两组比较差异无统计学意义(P>0.05)。两组患者不同时间点血流动力学及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: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,亦不影响血流动力学。Objective: To investigate the analgesic effect of Esketamine in patients undergoing thoracoscopic lung surgery. Methods: Seventy-six patients who underwent elective thoracoscopic assisted thoracic surgery in our hospital from January 2021 to June 2021 were selected and randomly divided into control group(group C) and esketamine group(group E), with 38 patients in each group. Patients in group E were given esketamine 0.5mg/kg 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, heart rate and BIS values were observed and compared between the two groups before and after administration at 1min, 2min, 3min, 5min, 15min, 15min and 30min. NRS scores at rest and during mobilization, postoperative analgesic drug use, postoperative adverse reactions and recovery of the two groups were recorded before surgery, immediately after surgery, 30min, 1h, 6h, 12h and 24h after surgery. Results:NRS scores during mobilization in group E were lower than those in the control group at 30min, 1h, 6h and 12h postoperatively, while NRS scores at rest were significantly different at 1h, 6h and 12h postoperatively(P<0.05), but there was no significant difference in RASS scores. The consumption of sufentanil was(13.33±3.71)μg in group E and(18.16±6.11)μg in group C,12 hours after surgery, with a P value of 0.008. At the second 12 hours after surgery, the consumption of sufentanil in E group was(10.77±3.88)μg,and that in control group was(12.38±4.33)μg and P value was 0.37. There were no significant differences in hemodynamics and incidence of postoperative adverse reactions between two groups(P>0.05).Conclusions: Esketamine can ease the intensity of early postoperative pain and reduce the consumption of analgesics in video-assisted thoracic surgery without affecting hemodynamics.

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]