临床误诊误治2025，Vol.38Issue(2)：34-40,7.DOI:10.3969/j.issn.1002-3429.2025.02.008
联合亚麻醉剂量艾司氯胺酮复合超声下椎旁阻滞应用于胸腔镜手术患者的临床价值
Clinical Value of Subanesthetic Dose of Esketamine Combined with Ultrasound-assisted Paraspinal Block in Patients Undergoing Thoracoscopic Surgery
摘要
Abstract
Objective To explore the clinical value of subanesthetic dose of Esketamine combined with ultrasound-assisted paraspinal block in patients undergoing thoracoscopic surgery.Methods A total of 308 patients scheduled for thora-coscopic surgery from December 2022 to March 2024 were selected and randomly divided into the Esketamine group(n=154)and the control group(n=154),according to random number table method.Both groups underwent ultrasound-guided pa-raspinal block under general anesthesia.The Esketamine group received an intravenous injection of 0.1 mg/kg Esketamine combined with ultrasound-guided paraspinal block,while the control group received an intravenous injection of an equivalent amount of 0.9%sodium chloride solution combined with ultrasound-guided paraspinal block.The visual analogue scale(VAS)pain scores at rest and during cough were compared between the two groups at 6,12,24,48,and 72 h after surgery.The heart rate(HR)and mean arterial pressure(MAP)were measured before anesthesia(T0),at 5 min after administration(T1),during the nerve block procedure(T2),at the beginning of surgery(T3),at 30 min after surgery(T4),and immedi-ately after surgery(T5).The scores of the mini-mental state examination(MMSE)were measured before surgery,at 24 h and 72 h after surgery.The recovery status and adverse reactions to anesthesia were also compared between the two groups.Re-sults The VAS scores of the Esketamine group at rest and during cough at 6,12,24,48,and 72 h after surgery were lower than those of the control group(P＜0.05),and at T2-T4,the HR and MAP in the Esketamine group were lower than those in the control group(P＜0.05).The MMSE scores of the Esketamine group were higher than those of the control group at 24 and 72 h after surgery(P＜0.05),and the use of Sufentanil and Tramadol in the Esketamine group was less than that in the control group at 72 h after surgery(P＜0.05,P＜0.01).The duration of stay in anesthesia recovery room after surgery,the first time of food intake and off-bed activity in the Esketamine group were shorter than those in the control group(P＜0.01).There was no significant difference in the total incidence of adverse reactions related to anesthesia between the two groups(P＞0.05).Conclusion The application of general anesthesia combined with subanesthetic dose of Esketamine combined with ultrasound-assisted paraspinal block in thoracoscopic surgery can effectively ensure the stability of the patient's hemody-namics,alleviate postoperative pain,reduce postoperative cognitive impairment,reduce the use of other analgesics,and im-prove the quality of postoperative recovery,which is safe and reliable.关键词
艾司氯胺酮/超声下椎旁阻滞/胸外科手术,电视辅助/全身麻醉/认知功能/疼痛,手术后/平均动脉压/药物毒性Key words
Esketamine/Ultrasound-guided paravertebral block/Thoracic surgery,video-assisted/General anesthe-sia/Cognitive function/Pain,after surgery/Mean arterial pressure/Drug toxicity分类
医药卫生引用本文复制引用
左明明,杨静,路敏,孙婧婧,张琳..联合亚麻醉剂量艾司氯胺酮复合超声下椎旁阻滞应用于胸腔镜手术患者的临床价值[J].临床误诊误治,2025,38(2):34-40,7.基金项目
2021年沧州市科技计划自筹经费项目(213106066) （213106066）
