艾司氯胺酮自控静脉镇痛在胸腔镜手术患者术后镇痛中的应用价值  

Application Value of Esketamine Patient-Controlled Intravenous Analgesia in Postoperative Analgesia of Patients with Thoracoscopic Surgery

作　　者：刘彤 林威威 陈东文 陈本桢 高洪光 蒋蓉蓉 李军祥 LIU Tong;LIN Weiwei;CHEN Dongwen;CHEN Benzhen;GAO Hongguang;JIANG Rongrong;LI Junxiang(Department of Anesthesiology,Chengdu Pidu District People's Hospital,Chengdu,Sichuan 611730,China;Department of Anesthesiology,Women and Children's Hospital Affiliated to Chengdu Medical College(Sichuan Women and Children's Hospital),Chengdu,Sichuan 610091,China)

机构地区：[1]成都市郫都区人民医院麻醉科,四川成都611730 [2]成都医学院附属妇女儿童医院/四川省妇女儿童医院麻醉科,四川成都611730

出　　处：《转化医学杂志》2025年第3期161-164,共4页Translational Medicine Journal

基　　金：四川省卫生健康委员会科研课题创新团队项目(24CXTD18);“医学赋能及人才培养计划”临床科研项目(CRCFYXFN-202201140)。

摘　　要：目的探究艾司氯胺酮联合患者自控静脉镇痛(PCIA)对胸腔镜肺叶切除术后患者镇痛效果及术后的影响。方法选取2023年1月至2024年11月成都市郫都区人民医院行胸腔镜下肺叶切除手术74例患者为研究对象,通过信封随机分组分为艾司氯胺酮组和对照组,每组37例。艾司氯胺酮组在患者自控静脉镇痛中加入艾司氯胺酮。对照组采用常规镇痛方案。比较2组患者术后疼痛[数字评定量表(NRS)]、慢性疼痛[慢性疼痛(CPSP)量表]、围手术期指标、术后疲劳(ICFS-10)、恢复质量(Qo R-15)、不良事件发生率差异。结果术后,2组静息状态NRS评分比较,差异无统计学意义(P>0.05),术后第2天,艾司氯胺酮组运动状态NRS评分、CPSP评分均低于对照组(P<0.05);艾司氯胺酮组舒芬太尼使用量及PCIA按压次数更少且首次下床时间低于对照组(P<0.05);术后不同时间点,艾司氯胺酮组ICFS-10评分均低于对照组(P<0.05),艾司氯胺酮组QoR-15评分均高于对照组(P<0.05);艾司氯胺酮组术后不良事件发生率低于对照组(P<0.05)。结论艾司氯胺酮联合PCIA可有效缓解胸腔镜术后运动性疼痛,降低慢性疼痛发生风险,减少阿片类药物用量,并通过改善术后疲劳程度和恢复质量促进患者早期康复,同时具有较好的安全性。Objective To investigate the effects of esketamine combined with patient-controlled intravenous analgesia(PCIA)on postoperative pain and recovery in patients undergoing video-assisted thoracoscopic lobectomy(VATS).Methods A total of 74 patients who underwent VATS lobectomy between January 2023 and November 2024 were enrolled and randomly assigned via sealed-envelope method to either the esketamine group(n=37)or the control group(n=37).The esketamine group received PCIA with esketamine added to the regimen,while the control group received standard PCIA.Postoperative pain[assessed by the Numerical Rating Scale(NRS)],chronic post-surgical pain(CPSP),perioperative indicators,postoperative fatigue(ICFS-10),quality of recovery(QoR-15)and incidence rates of adverse events were compared between the two groups of patients.Results There was no statistical significance in the NRS score in the resting state NRS scores between groups after surgery(P>0.05).On the 2nd day after surgery,the esketamine group exhibited lower NRS scores during movement(P<0.05),and lower CPSP scores compared to the control group(P<0.05).The esketamine group also required less sufentanil,fewer PCIA compressions,and had a shorter time to first ambulation(P<0.05).At different time points after surgery,the esketamine group showed lower ICFS-10 scores and higher QoR-15 scores than the control group(P<0.05).Additionally,the incidence of adverse events was significantly lower in the esketamine group(P<0.05).Conclusion Esketamine combined with PCIA effectively alleviates movement-associated pain after VATS,reduces the risk of CPSP,decreases opioid consumption,and enhances early recovery by improving postoperative fatigue and overall recovery quality,with a favorable safety profile.

关 键 词：肺叶切除术 胸腔镜 静脉自控镇痛 艾司氯胺酮 术后镇痛效果 

分 类 号：R614[医药卫生—麻醉学]