小剂量艾司氯胺酮对胸腔镜肺癌根治术患者术后恢复质量的影响

摘要
图/表
参考文献(25)
相关文章 (15)

全文: PDF (554 KB) HTML (1 KB)
输出: BibTeX | EndNote (RIS)

摘要目的评价小剂量艾司氯胺酮对胸腔镜肺癌根治术患者术后恢复质量的影响。方法选择2021年3月至10月西南医科大学附属医院行胸腔镜下肺癌根治术患者96例，采用随机数字表法将其分为艾司氯胺酮组（E组）和对照组（C组），每组48例。两组麻醉诱导方案相同，E组最后静脉注射艾司氯胺酮0.2 mg/kg，C组静脉注射等量生理盐水。比较两组麻醉时间、手术时间、拔管时间；比较两组术前1 d（T0）、术后24 h（T1）及48 h（T2）40项恢复质量量表（QoR-40）评分；记录两组T1时补救镇痛率及谵妄、恶心呕吐、视力模糊、头痛等并发症的发生情况；比较两组T2时失眠的发生率。结果两组麻醉时间、手术时间及拔管时间比较，差异无统计学意义（P ＞ 0.05）。E组术后失眠率低于C组（P ＜ 0.05）。与T0时比较，两组T1时QoR-40总分及情绪状态、身体舒适度、自理能力、心理支持、疼痛感受评分下降（P ＜ 0.01）；C组T2时QoR-40总分及疼痛感受评分下降（P ＜ 0.01）。与C组比较，E组T2时QoR-40总分、情绪状态评分增加，T1、T2时疼痛感受评分增加（P ＜ 0.01）。E组补救镇痛率低于C组（P ＜ 0.05）；两组并发症总发生率比较，差异无统计学意义（P ＞ 0.05）。结论小剂量艾司氯胺酮可减轻胸腔镜肺癌根治术患者术后疼痛，改善情绪状态和睡眠质量。

	服务

	把本文推荐给朋友
	加入我的书架
	加入引用管理器
	E-mail Alert
	RSS
	作者相关文章
	陈永旺唐霓肖万莉段晓霞刘玉林

关键词 ：艾司氯胺酮, 术后恢复质量, 胸腔镜, 肺肿瘤

Abstract：Objective To evaluate the effects of low-dose Esketamine on postoperative recovery quality of patients undergoing thoracoscopic radical resection of lung cancer. Methods A total of 96 patients who underwent thoracoscopic radical resection of lung cancer in the Affiliated Hospital of Southwest Medical University from March to October 2021 were selected. They were divided into Esmketamine group (group E) and control group (group C) by using random number table method, with 48 cases in each group. The anesthesia induction protocol of two groups was the same, group E was injected with Esmketamine 0.2 mg/kg intravenously, and group C was injected with the same amount of normal saline intravenously. Anesthesia time, operation time, and extubation time were compared between two groups; the score of 40-items quality of recovery scale (QOR-40) between two groups were compared at one day before operation (T0), 24 hours after operation (T1) and 48 hours after operation (T2). The rate of remedial analgesia and complications such as delirium, nausea and vomiting, blurred vision, and headache at T1 were recorded; the incidence of insomnia at T2 was compared between two groups. Results There were no significant differences in anesthesia time, operation time, extubation time between two groups (P > 0.05). The rate of postoperative insomnia in group E was lower than that in group C (P < 0.05). Compared with T0, the total scores of QoR-40, and the scores of emotional state, physical comfort, self-care ability, psychological support, and pain feeling scores at T1 of two groups were decreased, and the total scores of QoR-40 and the score of pain feeling at T2 in group C were decreased (P < 0.01). Compared with group C, the total scores of QoR-40 and the score of emotional state at T2 in group E were increased, and the pain feeling scores at T1 and T2 in group E were increased (P < 0.01). The remedial analgesia rate in group E was lower than that in group C (P < 0.05); there was no significant difference in the total incidence of complications between two groups (P > 0.05). Conclusion Low-dose Esmketamine can relieve postoperative pain, improve emotional state and sleep quality of patients undergoing thoracoscopic radical resection of lung cancer.

Key words： Esketamine Postoperative recovery quality Thoracoscopy Lung cancer

基金资助:四川省卫生和计划生育委员会科研课题（20PJ1 30）；
四川省泸州市人民政府西南医科大学科技战略合作项目（2019LZXNYDJ36）。

通讯作者: 刘玉林(1968.9-），男，硕士，副教授；研究方向：临床麻醉。

作者简介: 陈永旺(1993.4-），女，硕士；研究方向：临床麻醉。

引用本文:

陈永旺唐霓肖万莉段晓霞刘玉林. 小剂量艾司氯胺酮对胸腔镜肺癌根治术患者术后恢复质量的影响[J]. 中国医药导报, 2022, 19(19): 111-114.
CHEN Yongwang TANG Ni XIAO Wanli DUAN Xiaoxia LIU Yulin. Effects of low-dose Esmketamine on postoperative recovery quality of patients undergoing thoracoscopic radical resection of lung cancer. 中国医药导报, 2022, 19(19): 111-114.

链接本文:

https://www.yiyaodaobao.com.cn/CN/ 或 https://www.yiyaodaobao.com.cn/CN/Y2022/V19/I19/111

[1] 靳智勇，郭占林，康世荣.单孔和三孔胸腔镜在肺癌根治术中的应用效果比较[J].中国医药导报，2018，15（29）：120-123，128.
[2] Marshall K，McLaughlin K. Pain Management in Thoracic Surgery [J]. Thorac Surg Clin，2020，30（3）：339-346.
[3] Ida M，Onodera H，Yamauchi M，et al. Preoperative sleep disruption and postoperative functional disability in lung surgery patients：a prospective observational study [J]. J Anesth，2019，33（4）：501-508.
[4] Hu LH，Xu X，Shen WY，et al. Application of thoracoscopy-guided thoracic paravertebral block for analgesia after single-port video-assisted pulmonary lobectomy [J]. Zhonghua Yi Xue Za Zhi，2020，100（33）：2596-2600.
[5] Lei Y，Liu H，Xia F，et al. Effects of Esketamine on Acute and Chronic Pain After Thoracoscopy Pulmonary Surgery Under General Anesthesia：A Multicenter-Prospective，Randomized，Double-Blind，and Controlled Trial [J]. Front Med（Lausanne），2021，8：693594.
[6] Eberl S，Koers L，van Hooft J，et al. The effectiveness of a low-dose esketamine versus an alfentanil adjunct to propofol sedation during endoscopic retrograde cholangiopancreatography：A randomised controlled multicentre trial [J]. Eur J Anaesthesiol，2020，37（5）：394-401.
[7] 康艺涵，朱尤壮，秦上媛，等.艾司氯胺酮的研究进展[J].中国医师进修杂志，2021，44（5）：470-476.
[8] Joe YE，Kang CM，Lee HM，et al. Quality of Recovery of Patients Who Underwent Curative Pancreatectomy：Comparison of Total Intravenous Anesthesia Versus Inhalation Anesthesia Using the QOR-40 Questionnaire [J]. World J Surg，2021，45（8）：2581-2590.
[9] Wang X，Lin C，Lan L，et al. Perioperative intravenous S-ketamine for acute postoperative pain in adults：A systematic review and meta-analysis [J]. J Clin Anesth，2021，68：110071.
[10] 任芹，朱莉敏，许华，等.单次亚麻醉剂量氯胺酮对结直肠肿瘤患者术后早期情绪反应的影响[J].临床麻醉学杂志，2016，32（4）：317-320.
[11] 钱夏丽，夏凡，沈晓凤，等.艾司氯胺酮复合丙泊酚在宫腔镜检查术中的应用[J].临床麻醉学杂志，2021，37（7）：706-708.
[12] Singh JB，Fedgchin M，Daly E，et al. Intravenous Esketamine in Adult Treatment-Resistant Depression：A Double-Blind，Double-Randomization，Placebo-Controlled Study [J]. Biol Psychiatry，2016，80（6）：424-431.
[13] Bozymski KM，Crouse EL，Titus-Lay EN，et al. Esketamine：A Novel Option for Treatment-Resistant Depression [J]. Ann Pharmacother，2020，54（6）：567-576.
[14] Bahji A，Vazquez GH，Zarate CA Jr. Comparative efficacy of racemic ketamine and esketamine for depression：A systematic review and meta-analysis [J]. J Affect Disord，2021，278：542-555.
[15] Li P，Li Q，Yan H，et al. Effect of Pretreatment of S-Ketamine On Postoperative Depression for Breast Cancer Patients [J]. J Invest Surg，2021，34（8）：883-888.
[16] Li S，Luo X，Hua D，et al. Ketamine Alleviates Postoperative Depression-Like Symptoms in Susceptible Mice：The Role of BDNF-TrkB Signaling [J]. Front Pharmacol，2019，10：1702.
[17] Nielsen RV，Fomsgaard JS，Nikolajsen L，et al. Intraoperative S-ketamine for the reduction of opioid consumption and pain one year after spine surgery：A randomized clinical trial of opioid-dependent patients [J]. Eur J Pain，2019，23（3）：455-460.
[18] Pang L，Cui M，Dai W，et al. Can Intraoperative Low-Dose R，S-Ketamine Prevent Depressive Symptoms After Surgery? The First Meta-Analysis of Clinical Trials [J]. Front Pharmacol，2020，11：586104.
[19] 严佳敏，刘先保.联合应用艾司氯胺酮和舒芬太尼的剖宫产术后镇痛效果及抗抑郁作用[J].江苏医药，2021， 47（11）：1132-1135，1139.
[20] Jonkman K，van Rijnsoever E，Olofsen E，et al. Esketamine counters opioid-induced respiratory depression [J]. Br J Anaesth，2018，120（5）：1117-1127.
[21] Haack M，Simpson N，Sethna N，et al. Sleep deficiency and chronic pain：potential underlying mechanisms and clinical implications [J]. Neuropsychopharmacology，2020， 45（1）：205-216.
[22] Kushikata T，Sawada M，Niwa H，et al. Ketamine and propofol have opposite effects on postanesthetic sleep architecture in rats：relevance to the endogenous sleep-wakefulness substances orexin and melanin-concentrating hormone [J]. J Anesth，2016，30（3）：437-443.
[23] Cheng W，Rolls ET，Ruan H，et al. Functional Connectivities in the Brain That Mediate the Association Between Depressive Problems and Sleep Quality [J]. JAMA Psychiatry，2018，75（10）：1052-1061.
[24] 禚传君，田红军，张力，等.氯胺酮调控睡眠节律和突触内稳态的抗抑郁效应机制[J].中华行为医学与脑科学杂志，2019，28（3）：285-289.
[25] 房捷欣，肖乐，朱雪泉，等.氯胺酮治疗抑郁症抗自杀作用的初步研究[J].中国神经精神疾病杂志，2020，46（4）：226-228.