艾司氯胺酮对老年患者胸腔镜下肺癌根治术后呼吸抑制的影响

doi:10.11958/20230281

天津医药 ›› 2023, Vol. 51 ›› Issue (11): 1267-1270.doi: 10.11958/20230281

艾司氯胺酮对老年患者胸腔镜下肺癌根治术后呼吸抑制的影响

任齐齐¹(), 张伯康², 孔令锁¹^,²^,^△()

1.蚌埠医学院研究生院（邮编233030）
2.中国科学技术大学附属第一医院麻醉科

收稿日期:2023-03-02 修回日期:2023-04-27 出版日期:2023-11-15 发布日期:2023-11-07
通讯作者: ^△E-mail：konglingsuo3201@163.com
作者简介:任齐齐（1998），女，硕士在读，主要从事临床麻醉药物及围术期重要脏器保护方面研究。E-mail：3527593870@qq.com
基金资助:
湖北陈孝平科技发展基金会资助项目(CXPJJH12000005-07-11);“科大新医学”联合基金(WK9110000090)

Effects of esketamine on respiratory depression after radical thoracoscopic resection of lung cancer in elderly patients

REN Qiqi¹(), ZHANG Bokang², KONG Lingsuo¹^,²^,^△()

1. School of Graduate, Bengbu Medical College, Bengbu 233030, China
2. Department of Anesthesiology, the First Affiliated Hospital of University of Science and Technology of China

Received:2023-03-02 Revised:2023-04-27 Published:2023-11-15 Online:2023-11-07
Contact: ^△E-mail：konglingsuo3201@163.com

任齐齐, 张伯康, 孔令锁. 艾司氯胺酮对老年患者胸腔镜下肺癌根治术后呼吸抑制的影响[J]. 天津医药, 2023, 51(11): 1267-1270.

REN Qiqi, ZHANG Bokang, KONG Lingsuo. Effects of esketamine on respiratory depression after radical thoracoscopic resection of lung cancer in elderly patients[J]. Tianjin Medical Journal, 2023, 51(11): 1267-1270.

摘要/Abstract

摘要：

目的探讨艾司氯胺酮对老年患者胸腔镜下肺癌根治术后呼吸抑制的影响。方法选取全身麻醉胸腔镜下行肺癌根治术的老年患者60例，按随机数字表法分为观察组（30例）和对照组（30例）。术后行患者自控静脉镇痛，观察组镇痛配方为艾司氯胺酮0.2 mg/kg+舒芬太尼1.3 μg/kg+地塞米松5 mg+右美托咪定100 μg，对照组镇痛配方为舒芬太尼1.5 μg/kg+地塞米松5 mg+右美托咪定100 μg。记录患者术后4、8、24、48 h静息和运动时疼痛视觉模拟量表（VAS）评分和Ramsay镇静评分；采用蒙特利尔认知评估量表（MoCA）于术前1 d，术后1、3 d评估认知功能；记录手术时间、住院时间和补救镇痛率及患者的术后并发症情况。结果观察组住院时间短于对照组（P<0.05）。术后48 h内2组静息时疼痛VAS评分差无统计学意义。术后4、8、24、48 h观察组运动时疼痛VAS评分明显低于对照组（P<0.05）。术后48 h内观察组患者Ramsay评分高于对照组（P<0.05）。2组患者MoCA评分差异均无统计学意义。观察组补救镇痛率、低血压、头晕、呼吸抑制发生率低于对照组（P<0.05），2组恶心呕吐发生率差异无统计学意义。结论艾司氯胺酮可为老年患者胸腔镜下肺癌手术术后提供更好的镇痛、镇静效果，减少住院时间，降低术后呼吸抑制、低血压和头晕发生率。

关键词: 肺肿瘤, 胸腔镜, 艾司氯胺酮, 老年患者, 呼吸抑制

Abstract:

Objective To investigate the effect of esketamine on respiratory depression after radical thoracoscopic resection of lung cancer in elderly patients. Methods Sixty elderly patients undergoing radical operation of lung cancer under general anesthesia were selected and divided into the observation group (30 cases) and the control group (30 cases) according to random number table method. Patient-controlled intravenous analgesia was performed after surgery. The analgesic formula in the observation group was esketamine 0.2 mg/kg+Sufentanil 1.3 μg/kg+dexamethasone 5 mg+dexmedetomidine 100 μg, and the analgesic formula of the control group was Sufentanil 1.5 μg/kg+ dexamethasone 5 mg+ dexmedetomidine 100 μg. Visual analog scale (VAS) at rest and during exercise and Ramsay sedation score were recorded at 4, 8, 24 and 48 h after surgery. The Montreal Cognitive Assessment Scale (MoCA) was used to assess cognitive function 1 day before surgery and 1 and 3 days after surgery. The duration of operation, length of hospital stay, rate of remedial analgesia and postoperative complications were recorded. Results The hospitalization time of the observation group was shorter than that of the control group (P<0.05). There was no significant difference in resting VAS score within 48 h after surgery between the two groups. The VAS scores at 4, 8, 24 and 48 h after operation were significantly lower in the observation group than those of the control group (P<0.05). Ramsay scores within 48 h after surgery were higher in the observation group than those in the control group (P<0.05). There were no significant differences in MoCA scores between the two groups. Incidence rates of analgesia, hypotension, dizziness and respiratory depression were lower in the observation group than those in the control group (P<0.05), and there were no significant differences in incidences of nausea and vomiting between the two groups. Conclusion Esketamine can provide better analgesia and sedation after thoracoscopic lung cancer surgery in elderly patients, reduce hospital stay, and reduce the incidence of postoperative respiratory depression, hypotension and dizziness.

Key words: lung neoplasms, thoracoscopes, esketamine, elderly patients, respiratory depression

中图分类号:

R614

图/表 5

参考文献 21

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组别	n	性别（男/女）	年龄/岁	BMI/（kg/m²）	ASA分级（Ⅱ/Ⅲ）	手术时间/min	住院时间/d	合并症
组别	n	性别（男/女）	年龄/岁	BMI/（kg/m²）	ASA分级（Ⅱ/Ⅲ）	手术时间/min	住院时间/d	高血压	糖尿病
对照组	30	18/12	66.57±5.74	23.13±2.63	9/21	112.00±47.95	9.93±3.24	10	2
观察组	30	20/10	67.23±7.99	23.27±2.45	8/22	116.33±46.80	8.47±1.68	10	3
t或χ²		0.287	0.371	0.212	0.082	0.354	2.204^＊	0.000	0.218

组别	n	性别（男/女）	年龄/岁	BMI/（kg/m²）	ASA分级（Ⅱ/Ⅲ）	手术时间/min	住院时间/d	合并症
组别	n	性别（男/女）	年龄/岁	BMI/（kg/m²）	ASA分级（Ⅱ/Ⅲ）	手术时间/min	住院时间/d	高血压	糖尿病
对照组	30	18/12	66.57±5.74	23.13±2.63	9/21	112.00±47.95	9.93±3.24	10	2
观察组	30	20/10	67.23±7.99	23.27±2.45	8/22	116.33±46.80	8.47±1.68	10	3
t或χ²		0.287	0.371	0.212	0.082	0.354	2.204^＊	0.000	0.218

组别	n	静息
组别	n	4 h	8 h	24 h	48 h
对照组	30	2.13±0.82	2.67±0.48	1.90±0.85	1.13±0.82
观察组	30	2.10±0.85	2.60±0.50	1.87±0.82	0.77±0.43
组别	n	运动
组别	n	4 h	8 h	24 h	48 h
对照组	30	4.13±0.82	6.23±0.86	5.20±0.85	4.17±0.91
观察组	30	3.43±0.63	5.13±0.82	4.07±0.87	3.47±0.73
t		3.718^＊＊	5.077^＊＊	5.118^＊＊	3.280^＊＊

组别	n	静息
组别	n	4 h	8 h	24 h	48 h
对照组	30	2.13±0.82	2.67±0.48	1.90±0.85	1.13±0.82
观察组	30	2.10±0.85	2.60±0.50	1.87±0.82	0.77±0.43
组别	n	运动
组别	n	4 h	8 h	24 h	48 h
对照组	30	4.13±0.82	6.23±0.86	5.20±0.85	4.17±0.91
观察组	30	3.43±0.63	5.13±0.82	4.07±0.87	3.47±0.73
t		3.718^＊＊	5.077^＊＊	5.118^＊＊	3.280^＊＊

组别	n	术后4 h	术后8 h	术后24 h	术后48 h
对照组	30	1.53±0.51	1.60±0.50	1.77±0.43	1.93±0.25
观察组	30	1.83±0.38	1.87±0.35	1.97±0.18	1.97±0.18

艾司氯胺酮对老年患者胸腔镜下肺癌根治术后呼吸抑制的影响

Effects of esketamine on respiratory depression after radical thoracoscopic resection of lung cancer in elderly patients

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组别	n	术前1 d	术后1 d	术后3 d
对照组	30	28.53±1.01	27.60±0.86	28.53±1.01
观察组	30	28.73±1.11	27.80±0.93	28.73±1.11

组别	n	补救镇痛	恶心呕吐	呼吸抑制	低血压	头晕
对照组	30	9（30.00）	8（26.67）	6（20.00）	10（33.33）	8（26.67）
观察组	30	2（6.67）	6（20.00）	0（0）	3（10.00）	1（3.33）
χ²		5.455^＊	0.373	6.667^＊	4.812^＊	4.706^＊

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