亚麻醉剂量艾司氯胺酮对食管癌根治术单肺通气患者的肺保护作用  

Pulmonary protective effects of subanesthetic dose of esketamine in patients undergoing radical esophagectomy with one-lung ventilation

作　　者：任小栋 袁静静[1] 李兰兰[1] 尚学栋 周立君[1] 韩雪萍[1] 孙振涛[1] REN Xiaodong;YUAN Jingjing;LI Lanlan;SHANG Xuedong;ZHOU Lijun;HAN Xueping;SUN Zhentao(Department of Anesthesia and Perioperative Medicine,the First Affiliated Hospital,Zhengzhou University,Henan Province International Joint Laboratory of Pain,Cognition and Emotion,Zhengzhou 450052)

机构地区：[1]郑州大学第一附属医院麻醉与围术期医学部,河南省疼痛认知与情绪研究国际联合实验室,郑州450052

出　　处：《郑州大学学报（医学版）》2023年第3期382-387,共6页Journal of Zhengzhou University(Medical Sciences)

基　　金：河南省卫生系统出国研修项目(2016021);河南省医学科技攻关计划项目(2018010006)。

摘　　要：目的:评价亚麻醉剂量艾司氯胺酮对食管癌根治术单肺通气患者的肺保护作用。方法:选择择期行食管癌根治术的患者40例,年龄40~65岁,BMI 18.0~27.9 kg/m^(2),ASA分级Ⅰ~Ⅱ级,分为对照组(C组)和艾司氯胺酮组(EK组),每组20例。EK组切皮前即刻静脉注射艾司氯胺酮0.15 mg/kg,术中以0.15 mg/(kg·h)静脉泵注;C组输注等体积生理盐水。分别于诱导前即刻(T_(0))、切皮前即刻(T_(1))、单肺通气后90 min(T_(2))、恢复双肺通气后30 min(T_(3))行动脉血气分析并记录患者T_(0)~T_(3)时心率(HR)、平均动脉压(MAP),T_(1)~T_(3)时潮气量(VT)、气道峰压(Ppeak)、气道平均压(Pmean),计算T_(1)~T_(3)时氧合指数(OI)、肺泡动脉氧分压差(A-aDO_(2))、呼吸指数(RI)、动态肺顺应性(Cdyn);检测T_(0)、T_(2)、T_(3)及术后4 h(T_(4))时患者血浆TNF-α和IL-6含量。记录手术指标、术中心血管事件、苏醒指标及术后24 h内不良事件。结果:与T_(1)时比较,两组T_(2)、T_(3)时Ppeak、Pmean、A-aDO_(2)、RI升高,OI、Cdyn降低(P<0.05);与C组比较,EK组T_(2)、T_(3)时Ppeak、Pmean、A-aDO_(2)、RI降低,OI、Cdyn升高(P<0.05)。与T_(0)时比较,两组T_(2)~T_(4)时血浆TNF-α和IL-6含量升高(P<0.05);与C组比较,EK组T_(2)~T_(4)时血浆TNF-α和IL-6含量降低(P<0.05)。与C组比较,EK组术中瑞芬太尼用量减少,术中低血压发生率降低,拔管时间及麻醉复苏室停留时间缩短(P<0.05);两组术后24 h不良事件发生率比较差异无统计学意义(P>0.05)。结论:术中持续静脉输注亚麻醉剂量艾司氯胺酮可抑制食管癌根治术单肺通气患者围术期炎症反应,保护患者肺功能;同时减少术中阿片类药物的消耗,且血流动力学更稳定。Aim:To evaluate the pulmonary protective effects of subanesthetic dose of esketamine intraoperatively in patients undergoing radical esophagectomy with one-lung ventilation.Methods:A total 40 patients aged 40-65 years,with BMI of 18.0-27.9 kg/m^(2),and ASA gradeⅠorⅡ,undergoing radical esophagectomy were allocated into 2 groups(n=20),control group(group C)and esketamine group(group EK).In the EK group,esketamine(0.15 mg/kg)was injected intravenously just before surgery,and esketamine was continuously infused intravenously at 0.15 mg/(kg·h)during surgery.Group C received the equal volume of normal saline.The radial artery blood samples were collected for blood gas analysis just before anesthesia induction(T_(0)),before surgery(T_(1)),90 min after one-lung ventilation(T_(2)),and 30 min after resuming two-lung ventilation(T_(3));heart rate(HR),mean arterial pressure(MAP)from T_(0)to T_(3),tidal volume(VT),peak airway pressure(Ppeak),mean airway pressure(Pmean)from T_(1)to T_(3)were recorded;oxygenation index(OI),alveolar-artery oxygen partial pressure gradient(A-aDO_(2)),respiratory index(RI)and dynamic lung compliance(Cdyn)from T_(1)to T_(3)were calculated.The plasma contents of TNF-αand IL-6 were measured at T_(0),T_(2),T_(3)and 4 hours after surgery(T_(4)).The surgical index,intraoperative cardiovascular events,awakening index,and adverse events within 24 hours after surgery were recorded.Results:In the 2 groups,compared with T_(1),Ppeak,Pmean,A-aDO_(2)and RI were significantly increased,while OI and Cdyn were significantly decreased at T_(2)and T_(3)(P<0.05);compared with group C,Ppeak,Pmean,A-aDO_(2)and RI were significantly decreased while OI and Cdyn were significantly increased in group EK at T_(2)and T_(3)(P<0.05).In the 2 groups,compared with T_(0),the plasma contents of TNF-αand IL-6 were significantly increased at T_(2),T_(3),T_(4)(P<0.05);compared with group C,the contents of TNF-αand IL-6 were significantly decreased in group EK at T_(2),T_(3),T_(4)(P<0.05).Compared with group C,intraoperative r

关 键 词：艾司氯胺酮 亚麻醉剂量 单肺通气 肺功能 炎症反应 

分 类 号：R614.24[医药卫生—麻醉学]