艾司氯胺酮用于机械通气下行支气管肺泡灌洗术患儿肺保护的临床研究  

Clinical study of esketamine for lung protection in children undergoing bronchoalveolar lavage under mechanical ventilation

作　　者：陈铁胜 田振 靳新耀 潘熊熊[1] CHEN Tiesheng;TIAN Zhen;JIN Xinyao;PAN Xiongxiong(Department of Anesthesiology,the first affiliated hospital of Nanjing Medical University,Nanjing,Jiangsu 210029,China;Department of Anesthesiology,Suqian Hospital of Nanjing drum-tower Hospital Group,Suqian,Jiangsu 223800,China;Department of Pediatrics,Suqian Hospital of Nanjing drum-tower Hospital Group,Suqian,Jiangsu 223800,China)

机构地区：[1]南京医科大学第一附属医院麻醉科,江苏南京210029 [2]南京鼓楼医院集团宿迁医院麻醉科,江苏宿迁223800 [3]南京鼓楼医院集团宿迁医院儿科,江苏宿迁223800

出　　处：《临床肺科杂志》2025年第1期65-69,共5页Journal of Clinical Pulmonary Medicine

基　　金：江苏省宿迁市科技指导计划(No.Z2019179)。

摘　　要：目的 旨在明确艾司氯胺酮用于机械通气下行支气管肺泡灌洗术患儿肺保护的效果。方法 选取行支气管肺泡灌洗术患儿82例作为研究对象,按随机数字表法将所有患儿随机分为对照组与观察组,每组41例。对照组和观察组患儿的全麻诱导分别使用0.5 ug/kg舒芬太尼和0.5mg/kg艾司氯胺酮,对两组的呼吸力学指标、炎症因子、肺功能指标、复苏情况和不良反应进行比较。结果 在手术20 min和手术结束时,观察组的气道峰压和平均气道压均显著低于对照组(P<0.05),而观察组的肺动态顺应性显著高于对照组(P<0.05)。观察组在手术结束时的IL-6和TNF-α数值均显著低于对照组(P<0.05)。在麻醉后1d,观察组的FVC、FEV_(1)和PEF数值均显著高于对照组(P<0.05)。观察组的呼吸恢复、意识恢复和喉罩拔除时间均明显短于对照组(P<0.05)。观察组的围术期不良反应发生率显著低于对照组(P<0.05)。结论 艾司氯胺酮用于机械通气下行支气管肺泡灌洗术患儿,可以改善其呼吸力学指标,炎症因子水平明显降低,呼吸恢复、意识恢复和喉罩拔除时间更短,不良反应少,有利于肺保护。Objective To investigate the effect of esketamine on lung protection in children undergoing bronchoalveolar lavage under mechanical ventilation.Methods A total of 82 children who underwent bronchoalveolar lavage were selected as the study objects and all children were randomly divided into an observation group and control group according to the random number table method,with 41 cases in each group.The children in the control group and observation group were induced by general anesthesia using 0.5ug/kg sufentanil and 0.5mg/kg esketamine,respectively.The respiratory mechanics indexes,inflammatory factors,pulmonary function indexes,resuscitation,and adverse reactions of the two groups were compared.Results The peak airway pressure and mean airway pressure in the observation group were significantly lower than those in the control group at 20 min and at the end of surgery(P<0.05),and the dynamic lung compliance in the observation group was significantly higher than that in the control group(P<0.05).The levels of IL-6 and TNF-αin the observation group were significantly lower than those in the control group at the end of surgery(P<0.05).At 1 day after anesthesia,FVC,FEV_(1),and PEF values in the observation group were significantly higher than those in the control group(P<0.05).The respiratory recovery,consciousness recovery,and laryngeal mask removal times in the observation group were significantly shorter than those in the control group(P<0.05).The incidence of perioperative adverse reactions in the observation group was significantly lower than that in the control group(P<0.05).Conclusion The use of esketamine in children undergoing bronchoalveolar lavage under mechanical ventilation can improve their respiratory mechanical indexes,significantly reduce the level of inflammatory factors,shorten the time of breathing recovery,consciousness recovery,and laryngeal mask removal,and reduce adverse reactions,which is beneficial to lung protection.

关 键 词：艾司氯胺酮 机械通气 支气管肺泡灌洗术 肺保护 临床研究 

分 类 号：R726.1[医药卫生—儿科]