艾司氯胺酮对保留自主呼吸全身麻醉胸腔镜肺结节切除术中低氧血症的影响  

Effect of esketamine on hypoxemia during thoracoscopic pulmonary nodule resection under general anesthesia with preserved spontaneous respiration

作　　者：张晓静 任志强 梁文波 郑龙彬 秦卫民 马晴 尹宁 ZHANG Xiaojing;REN Zhiqiang;LIANG Wenbo;ZHENG Longbin;QIN Weimin;MA Qing;YIN Ning(Department of Anesthesiology,Sir Run Run Hospital,Nanjing Medical University,Nanjing 211100,China)

机构地区：[1]南京医科大学附属逸夫医院麻醉科,211100

出　　处：《临床麻醉学杂志》2023年第7期700-704,共5页Journal of Clinical Anesthesiology

摘　　要：目的探讨艾司氯胺酮对保留自主呼吸全身麻醉下行胸腔镜周围性肺结节切除术患者呼吸、循环和急性期炎性因子的影响。方法选择择期拟在全身麻醉下行胸腔镜周围性肺结节楔形切除术的患者84例,男45例,女39例,年龄18~64岁,BMI 18~25 kg/m^(2),ASAⅠ或Ⅱ级。采用随机数字表法将患者分为两组:艾司氯胺酮组(E组)和舒芬太尼组(S组),每组42例。两组麻醉诱导前10 min分别恒速静脉泵注右美托咪定0.4μg/kg,首量泵注结束后行胸椎旁神经阻滞(TPVB)。E组麻醉诱导给予艾司氯胺酮0.5 mg/kg,术中维持艾司氯胺酮0.5 mg·kg^(-1)·h^(-1)持续泵注。S组麻醉诱导给予舒芬太尼0.1μg/kg,术中维持瑞芬太尼0.05μg·kg^(-1)·min-1持续泵注。两组其余麻醉诱导和维持药物一致。记录术中低氧血症、心动过缓、低血压和体动发生情况。记录麻醉诱导前(t_(0))、置入喉罩后(t_(1))、打开胸膜后30 min(t_(2))、拔除喉罩前(t_(3))、送返病房前(t_(4))的HR、MAP、SpO_(2)、PaCO_(2)和PaO_(2)。记录t_(1)、t_(2)、t_(3)时V T、RR。于t_(0)及术后24 h(t_(5))时抽取肘正中静脉血3 ml,检测TNF-α、IL-6浓度。记录术后恶心呕吐、幻觉、谵妄、噩梦发生情况,口腔分泌物量和术后住院时间。结果与S组比较,E组术中低氧血症、心动过缓、低血压和体动发生率明显降低(P<0.05)。与t_(0)时比较,S组t_(1)时HR明显减慢,MAP明显降低,t_(1)、t_(2)、t_(3)时SpO_(2)明显降低(P<0.05)。与S组比较,E组t_(1)、t_(2)、t_(3)时SpO_(2)明显升高(P<0.05),t_(1)、t_(2)、t_(3)、t_(4)时PaCO_(2)明显降低、PaO_(2)明显升高(P<0.05),t_(1)、t_(2)时V_(T)明显增大、RR明显增快(P<0.05),t_(5)时静脉血TNF-α和IL-6浓度明显降低(P<0.05),恶心呕吐发生率明显降低,术后住院时间明显缩短(P<0.05)。两组幻觉、谵妄、噩梦发生率和口腔分泌物量差异无统计学意义。结论艾司氯胺酮可以降低保留自主呼吸全身麻醉下周�Objective To investigate the effects of esketamine on respiration,circulation and acute phase inflammatory factors in patients undergoing thoracoscopic peripheral pulmonary nodule resection under general anesthesia with preserved spontaneous respiration.Methods Eighty-four patients,45 males and 39 females,aged 18-64 years,BMI 18-25 kg/m^(2),ASA physical statusⅠorⅡ,who were scheduled to undergo thoracoscopic wedge resection of peripheral pulmonary nodules under general anesthesia were selected.The patients were randomly divided into two groups by random number table:esketamine group(group E)and sufentanil group(group S),42 patients in each group.The two groups were injected with 0.4μg/kg dexmedetomidine by constant velocity intravenous pump 10 minutes before anesthesia induction respectively,and thoracic paravertebral block(TPVB)was performed after the initial injection.Esketamine 0.5 mg/kg was given in group E for induction of anesthesia,and esketamine 0.5 mg·kg^(-1)·h^(-1)was continuously pumped for intraoperative maintenance.In group S,sufentanil was given at_(0).1μg/kg for induction of anesthesia,and remifentanil at 0.05μg·kg^(-1)·min^(-1) for intraoperative maintenance.Other anesthesia induction and maintenance drugs in both groups were the same.Hypoxemia,bradycardia,hypotension and body movement during operation were recorded.HR,MAP,SpO_(2),PaCO_(2),and PaO_(2)were recorded before anesthesia induction(t_(0)),after laryngeal mask placement(t_(1)),30 minutes after pleura opening(t_(2)),before laryngeal mask removal(t_(3))and before return to ward(t_(4)).V_(T) and RR were recorded at t_(1),t_(2),and t_(3).3 ml of blood was extracted from the median cubital vein at t_(0) and 24 hours after surgery(t_(5))to detect the concentrations of TNF-αand IL-6.The incidence of nausea,vomiting,hallucinations,delirium,nightmares,the amount of oral secretions and the length of postoperative hospital stay were recorded.Results Compared with group S,the incidence of hypoxemia,bradycardia,hypotension and motility were

关 键 词：艾司氯胺酮 胸腔镜 非气管插管全身麻醉 保留自主呼吸 炎性因子 

分 类 号：R614[医药卫生—麻醉学]