艾司氯胺酮联合竖脊肌平面阻滞在胸腔镜肺部手术患者中的应用  

Application of esketamine combined with erector spinal muscle plane block in patients undergoing thoracoscopic lung surgery

作　　者：张娜娜 周俊辉[1] 任苏恩[1] 钟巍[1] ZHANG Na-na;ZHOU Jun-hui;REN Su-en;ZHONG Wei(Department of Anesthesiology,Henan Chest Hospital,Zhengzhou 450001,Henan,CHINA)

机构地区：[1]河南省胸科医院麻醉科,河南郑州450001

出　　处：《海南医学》2025年第7期945-948,共4页Hainan Medical Journal

基　　金：河南省医学科技攻关计划联合共建项目(编号:LHGJ20200220)。

摘　　要：目的探讨艾司氯胺酮联合竖脊肌平面阻滞(ESPB)在胸腔镜肺部手术患者中的应用效果。方法选择2022年7月至2024年7月河南省胸科医院收治的102例接受胸腔镜肺部手术的患者作为研究对象,按随机数表法分为观察组和对照组各51例。对照组患者采用ESPB麻醉,术后使用舒芬太尼进行静脉自控镇痛(PCIA),观察组患者在对照组的基础上联合艾司氯胺酮麻醉,术后使用舒芬太尼联合艾司氯胺酮进行PCIA。比较两组患者的围术期指标、术后不同时间点视觉模拟评分(VAS)和术前、术后24 h的皮质醇(Cor)、去甲肾上腺素(NE)、肾上腺素(E)水平,比较两组患者的不良反应发生率。结果观察组患者术中丙泊酚用量、术中瑞芬太尼用量、术后PCIA按压次数、术后舒芬太尼用量分别为(538.34±105.93)mg、(1123.71±251.94)μg、(6.23±1.22)次、(59.02±14.85)μg,明显少于对照组的(723.15±186.33)mg、(1675.28±31.83)μg、(8.41±1.49)次、(76.45±17.33)μg,差异均有统计学意义(P<0.05);观察组患者术后4 h、8 h、12 h、24 h的VAS评分分别为(2.94±0.53)分、(2.71±0.60)分、(2.43±0.59)分、(2.22±0.45)分,明显低于对照组的(3.43±0.68)分、(3.06±0.73)分、(2.88±0.63)分、(2.65±0.53)分,差异均有统计学意义(P<0.05);观察组患者术后24 h的Cor、NE、E水平分别为(308.34±35.72)nmol/L、(169.03±21.52)ng/L、(41.12±5.26)ng/L,明显低于对照组的(336.52±41.65)nmol/L、(184.64±25.35)ng/L、(46.45±5.74)ng/L,差异均有统计学意义(P<0.05);观察组患者的不良反应总发生率为7.84%,明显低于对照组的23.53%,差异有统计学意义(P<0.05)。结论艾司氯胺酮联合ESPB可缓解胸腔镜肺部手术患者术后疼痛、应激反应,并降低不良反应发生率,具有临床应用价值。Objective To investigate the effect of esketamine combined with erector spinal plane block(ESPB)in patients undergoing thoracoscopic pulmonary surgery.Methods A total of 102 patients who underwent thoracoscopic lung surgery at Henan Chest Hospital from July 2022 to July 2024 were selected as the study subjects.They were divided into an observation group and a control group,with 51 patients in each group,using a random number table method.Patients in the control group received ESPB anesthesia and postoperative patient-controlled intravenous analgesia(PCIA)with sufentanil,while those in the observation group received esketamine combined with ESPB anesthesia and postoperative PCIA with sufentanil and esketamine.Perioperative indicators,Visual Analog Scale(VAS)scores at different time points after surgery,cortisol(Cor),norepinephrine(NE),and epinephrine(E)levels before and 24 hours after surgery,and the incidence of adverse reactions were compared between the two groups.Results The intraoperative propofol dosage,intraoperative remifentanil dosage,postoperative PCIA compression times,and postoperative sufentanil dosage in the observation group were(538.34±105.93)mg,(1,123.71±251.94)μg,(6.23±1.22)times,and(59.02±14.85)μg,respectively,which were significantly lower than(723.15±186.33)mg,(1,675.28±31.83)μg,(8.41±1.49)times,and(76.45±17.33)μg in the control group(P<0.05).The VAS scores at 4 h,8 h,12 h,and 24 h after surgery in the observation group were(2.94±0.53)points,(2.71±0.60)points,(2.43±0.59)points,and(2.22±0.45)points,respectively,which were significantly lower than(3.43±0.68)points,(3.06±0.73)points,(2.88±0.63)points,and(2.65±0.53)points in the control group(P<0.05).The Cor,NE,and E levels at 24 h after surgery in the observation group were(308.34±35.72)nmol/L,(169.03±21.52)ng/L,and(41.12±5.26)ng/L,respectively,which were significantly lower than(336.52±41.65)nmol/L,(184.64±25.35)ng/L,and(46.45±5.74)ng/L in the control group(P<0.05).The total incidence of adverse reactions in the observa

关 键 词：胸腔镜手术 竖脊肌平面阻滞 艾司氯胺酮 镇痛 应激反应 

分 类 号：R655.3[医药卫生—外科学]