摘要
目的评价艾司氯胺酮围术期全程镇痛用于胸腔镜肺叶切除术患者的效果。方法择期全麻下行胸腔镜肺叶切除术患者90例,性别不限,年龄18~64岁,BMI 18~30 kg/m^(2),ASA分级Ⅰ或Ⅱ级。采用随机数字表法分为3组(n=30):对照组(C组)和不同剂量艾司氯胺酮组(S_(1)组和S_(2)组)。S_(1)组和S_(2)组于麻醉诱导前分别静脉注射艾司氯胺酮0.1和0.2 mg/kg。3组均常规麻醉诱导。麻醉维持时S_(1)组和S_(2)组分别静脉输注艾司氯胺酮0.1、0.2 mg·kg^(-1)·h^(-1),3组其余麻醉维持药物相同。术后行PCIA,C组药物为舒芬太尼2 μg/kg,S_(1)组和S_(2)组在此基础上混合艾司氯胺酮1 mg/kg。采用酮咯酸氨丁三醇补救镇痛,维持静态疼痛NRS评分≤3分。记录术中丙泊酚和瑞芬太尼总量、术后0~24 h和>24~48 h PCIA有效按压次数及补救镇痛情况;记录术后呼吸抑制、恶心呕吐、头晕、流涎等不良反应发生情况和苏醒时间。于术前30 min和术后30 min时采用ELISA法测定血清IL-6浓度,采用硫代巴比妥酸比色分析法测定血清MDA浓度。于术后1和2 d时采用15项恢复质量(QoR-15)量表评估术后恢复情况。于术后1~3个月电话随访慢性疼痛的发生情况。结果与C组比较,S_(1)组和S_(2)组术中瑞芬太尼用量、术后0~24 h和术后>24~48 h PCIA有效按压次数、补救镇痛率、术后血清IL-6浓度降低,QoR-15量表评分升高,S_(2)组术后血清MDA浓度降低(P<0.05);与S_(1)组比较,S_(2)组术中瑞芬太尼用量降低(P<0.05),术后血清IL-6和MDA浓度差异无统计学意义(P>0.05)。与S_(2)组比较,S_(1)组和C组术后苏醒时间缩短(P<0.05)。3组术中丙泊酚用量、不良反应发生率、慢性疼痛发生率差异无统计学意义(P>0.05)。结论艾司氯胺酮围术期全程镇痛(麻醉诱导前剂量0.1 mg/kg、麻醉维持剂量0.1 mg·kg^(-1)·h^(-1),术后PCIA剂量1 mg/kg)用于胸腔镜肺叶切除术患者可提高镇痛质量,改善术后早期康复质量。
Objective To evaluate the efficacy of perioperative analgesia with esketamine in the patients undergoing thoracoscopic surgery.Methods A total of 90 patients of either sex,aged 18-64 yr,with body mass index of 18-30 kg/m^(2),of American Society of Anesthesiologists Physical Status classificationⅠorⅡ,scheduled for elective thoracoscopic lobectomy under general anesthesia,were divided into 3 groups(n=30 each)by a random number table method:control group(C group)and different doses of esketamine groups(S_(1) group,S_(2) group).Before induction of anesthesia,esketamine 0.1 and 0.2 mg/kg were intravenously injected in S_(1) group and S_(2) group,respectively,while esketamine was not given in group C.Anesthesia was routinely induced in all the three groups.During anesthesia maintenance,esketamine 0.1 and 0.2 mg·kg^(-1)·h^(-1) were intravenously infused in group S_(1) and group S_(2),respectively,and the remaining drugs used for anesthesia maintenance were the same in the three groups.Patient-controlled intravenous analgesia(PCIA)was used after operation,and PCIA solution contained sufentanil 2μg/kg in group C,and esketamine 1 mg/kg was mixed on the basis as previously described in S_(1) and S_(2) groups.Aminotriol ketorolac was given as rescue analgesia to maintain numeric rating scale score at rest≤3.The total amount of propofol and remifentanil during operation,effective pressing times of PCIA in postoperative 0-24 h and>24-48 h periods,and requirement for rescue analgesia were recorded.The occurrence of adverse reactions such as respiratory depression,nausea and vomiting,dizziness and salivation,and emergence time were recorded after surgery.The serum interleukin-6(IL-6)concentration was measured by enzyme-linked immunosorbent assay at 30 min before and after surgery,and the malondialdehyde(MDA)concentration in serum was measured by thiobarbituric acid colorimetric analysis.The postoperative recovery was assessed using the 50-item quality of recovery scale at 1 and 2 days after surgery.The development of ch
作者
张建友
张天虹
刘凤霞
王溢鑫
唐苏红
邢智
郭淼
Zhang Jianyou;Zhang Tianhong;Liu Fengxia;Wang Yixin;Tang Suhong;Xing Zhi;Guo Miao(Department of Anesthesiology,Affiliated Hospital of Yangzhou University,Yangzhou 225000,China)
出处
《中华麻醉学杂志》
CAS
CSCD
北大核心
2024年第2期199-203,共5页
Chinese Journal of Anesthesiology
