艾司氯胺酮与长托宁对乳腺手术患者呛咳反应、TLR4/NF-κB的影响  

Effect of low-dose esketamine and pentoethylquine hydrochloride on choking response and TLR4/NF-κB in patients undergoing breast surgery

作　　者：赵云[1] 任学军[1] 李阿丽 ZHAO Yun;REN Xuejun;LI Ali(Department of Anesthesiology,the First Affiliated Hospital of Henan University of Chinese Medicine,Zhengzhou,Henan,China,450000)

机构地区：[1]河南中医药大学第一附属医院麻醉科,河南郑州450000

出　　处：《分子诊断与治疗杂志》2025年第2期304-308,共5页Journal of Molecular Diagnostics and Therapy

基　　金：河南省卫生健康委员会项目(20-21ZY2197)。

摘　　要：目的探讨小剂量艾司氯胺酮联合长托宁在乳腺良性肿块切除中的应用效果以及对呛咳反应和Toll样受体4/核因子-κB(TLR4/NF-κB)通路的影响。方法纳入2023年9月至2024年6月期间在河南中医药大学第一附属医院行乳腺良性肿块切除的90例女性患者,采用随机数表法分为对照组(45例,给予长托宁)和研究组(45例,给予小剂量艾司氯胺酮联合长托宁)。比较两组患者的手术体征、不良反应、呛咳情况以及术前术后TLR4/NF-κB通路表达情况。结果两组术前(T1)的平均动脉压(MAP)和心率以及苏醒时间相比较,差异无统计学意义(P>0.05)。研究组静脉给药1 min后(T2)的MAP和心率显著高于对照组,喉罩拔出时(T3)和拔出后5 min(T4)的MAP和心率则显著低于对照组,差异具有统计学意义(P<0.05)。研究组和对照组的不良反应发生率分别为15.56%和6.67%,差异无统计学意义(P>0.05)。研究组静脉注射舒芬太尼后的呛咳发生率和呛咳程度均显著低于对照组,差异具有统计学意义(P<0.05)。研究组TLR4、NF-κB以及髓性分化原发应答基因88(MyD88)的mRNA相对表达量均显著低于对照组,差异具有统计学意义(P<0.05)。结论小剂量艾司氯胺酮联合长托宁在乳腺良性肿块患者切除术中的应用安全有效,可减轻麻醉诱发的呛咳反应,抑制TLR4/NF-κB通路的表达。Objective To investigate the effect of low-dose esketamine combined with pentoethylquine hydrochloride in benign breast lumpectomy and its effect on cough response and Toll-like receptor 4/nuclear factor-κB(TLR4/NF-κB)pathway.Methods A total of 156 female patients who underwent benign breast lumpectomy at the First Affiliated Hospital of Henan University from September 2023 to June 2024 were enrolled and divided into the control group(45 cases,giving pentoethylquine hydrochloride)and the research group(45 cases,giving low-dose esketamine combined with pentoethylquine hydrochloride).The surgical signs,adverse reactions,choking,and expression of TLR4/NF-κB pathway before and after surgery were compared between the two groups.Results Mean arterial pressure(MAP)and heart rate in preoperatively(T1)and at the time of awakening were compared between the two groups,and the differences were not statistically significant(P>0.05).MAP and heart rate were significantly higher in the research group than in the control group one minute after intravenous administration(T2),while MAP and heart rate at the time of laryngeal mask withdrawal(T3)and 5 minutes after withdrawal(T4)were significantly lower than those in the control group,with a statistically significant difference(P<0.05).The incidence of adverse reactions in the research group and the control group were 15.56%and 6.67%,respectively,and the difference was not statistically significant(P>0.05).The incidence and the severity of choking after intravenous sufentanil administration in the research group were significantly lower than those in the control group(P<0.05).The relative mRNA expressions of TLR4,NF-κB,and myeloid differentiation primary response gene 88(MyD88)in the research group were significantly lower than those in the control group,and the difference was statistically significant(P<0.05).Conclusion The application of low-dose esketamine in combination with pentoethylquine hydrochloride during the benign breast masses has been proven to be both effective and

关 键 词：艾司氯胺酮 长托宁 乳腺良性肿块切除 呛咳反应 Toll样受体4/核因子-κB通路 

分 类 号：R73[医药卫生—肿瘤]