腹腔镜外科杂志2025，Vol.30Issue(3)：220-225,233,7.DOI:10.13499/j.cnki.fqjwkzz.2025.03.220
艾司氯胺酮低阿片化麻醉对胸腔镜手术后患者早期恢复质量的影响
Effect of esketamine low-opioid anesthesia on the quality of early recovery of patients after thoracoscopic surgery
摘要
Abstract
Objective:To investigate the effect of ultrasound-guided thoracic paravertebral nerve block combined with low-opi-oid anesthesia on the quality of early recovery of patients after thoracoscopic surgery.Methods:A total of 60 patients who underwent elective thoracoscopic radical lung cancer resection from Aug.2022 to Dec.2023 were selected,and the patients were divided into two groups according to the random number table method:esketamine group(E group,n=30)and sufentanil group(SF group,n=30).Before anesthesia induction,the T4 and T6 spaces were selected for ultrasound-guided thoracic paravertebral block in the two groups.Anesthesia induction regimen:E group:esketamine 0.5 mg/kg+propofol 2 mg/kg+rocuronium bromide 0.6 mg/kg,postoperative anal-gesic pump formula was esketamine 1.5 mg/kg+nisone 180 mg+azasetron 10 mg,background dose 2 mL/h;SF group:sufentanil 0.5 μg/kg+propofol 2 mg/kg+rocuronium bromide 0.6 mg/kg,postoperative analgesic pump formula was sufentanil 2 μg/kg+azasetron 10 mg,background dose 2 mL/h,and remifentanil 0.1 μg·kg-1·min-1 was continuously pumped during the operation.The systolic blood pressure,diastolic blood pressure and heart rate of the patients were recorded before anesthesia induction,after anesthesia induction,immediately after intubation,skin incision,extubation and 2 h after extubation.The visual analogue scores of resting and dynamic pain at 4 h,8 h,12 h and 24 h after surgery were recorded.The number of effective compressions and the dosage of salvage analgesics within 48 h after surgery were recorded.The 15-item recovery quality scores of the patients were followed up on the 1 d before surgery,1 d,3 d and 5 d after surgery,and the occurrence of postoperative adverse reactions was comparatively analyzed.Results:The systolic blood pressure,diastolic blood pressure and heart rate of E group were higher than those of SF group after anesthesia induction(P<0.05),and there were no significant differences in systolic blood pressure,diastolic blood pressure,heart rate between the two groups at other time points(P>0.05).No significant differences were found between the two groups in resting and dynamic pain visual analogue scores.The 15-item recovery quality scores of the E group were higher than those of the SF group on the 1 d,3 d and 5 d after surgery,the incidence of nausea and vomiting of the E group was lower than that of the SF group(P<0.05).Conclusions:Ultrasound-guided thoracic paravertebral nerve block combined with esketamine-based low-opioid anesthesia can meet the analgesic needs of patients undergoing thoracoscopic lobectomy,and the perioperative hemodynamics are more stable,the incidence of postoperative nausea and vomiting is lower,and the quality of postoperative recovery is improved.关键词
麻醉/胸腔镜检查/艾司氯胺酮/低阿片化/舒芬太尼Key words
Anesthesia/Thoracoscopy/Esketamine/Low opioid/Sufentanil分类
临床医学引用本文复制引用
胡敬利,李杨,史斌,刘付玉,刘国强,李志冰..艾司氯胺酮低阿片化麻醉对胸腔镜手术后患者早期恢复质量的影响[J].腹腔镜外科杂志,2025,30(3):220-225,233,7.基金项目
山东省医学会舒适化医疗科研专项资金项目(YXH2022ZX04248) （YXH2022ZX04248）
山东省临沂市科技发展计划项目(2023YX0048) （2023YX0048）
