山东医药2025，Vol.65Issue(10)：53-57,62,6.DOI:10.3969/j.issn.1002-266X.2025.10.011
亚麻醉剂量艾司氯胺酮对Trendelenburg体位腹腔镜手术肥胖患者肺损伤的影响
Effect of subanesthetic dose of esketamine on lung injury in obese patients undergoing laparoscopic surgery in Trendelenburg position
摘要
Abstract
Objective To investigate the effect of subanesthetic dose of esketamine on pulmonary injury in obese pa-tients undergoing laparoscopic surgery in the Trendelenburg position.Methods Fifty-six obese patients(BMI≥28 kg/m2)scheduled for elective laparoscopic surgery under general anesthesia in the Trendelenburg position were selected.The patients were divided into two groups by random number table:esketamine group and control group,with 28 patients in each group.During anesthesia induction,patients in the esketamine group received an intravenous injection of 0.2 mg/kg esketamine,followed by a continuous infusion of 0.125 mg/(kg·h)until 30 minutes before surgery completion.Patients in the control group received an equal volume of normal saline.The following parameters were recorded:surgery-related in-dicators[preoperative oxygen saturation(SpO2),volumes of intraoperative crystalloid-colloid infusion,the duration of Trendelenburg position combined with pneumoperitoneum and mechanical ventilation duration],respiratory mechanics-re-lated indicators[driving pressure(DP)and dynamic lung compliance(Cdyn)at 5 min after mechanical ventilation(T1),1 h after Trendelenburg position combined with pneumoperitoneum(T2),2 h after Trendelenburg position combined with pneumoperitoneum(T3),and 5 min before surgery end(T4)],blood gas analysis-related parameters[oxygenation index(OI)and alveolar-arterial oxygen gradient(PA-aO2)before anesthesia induction(T0),at T1,T3,and 5 min before PACU discharge(T5)],inflammatory-related markers[serum concentrations of Clara cell secretory protein(CC-16),and inter-leukin-6(IL-6)at T0 and T4],total propofol and remifentanil consumption,the incidence of adverse reactions and postop-erative pulmonary complications(PPCs).Results No significant differences were found in preoperative SpO2,volumes of intraoperative crystalloid-colloid infusion,the duration of Trendelenburg position combined with pneumoperitoneum or mechanical ventilation duration between the two groups(all P>0.05).Compared with those at T1,DP increased and Cdyn decreased in both groups at T2 and T3(both P<0.05);compared with those at T0,OI decreased and PA-aO2 increased at T1 and T3 in each group(both P<0.05);the serum CC-16 and IL-6 levels were elevated in both groups.Compared with the control group at the same time point,DP decreased at T3 and T4,OI increased while PA-aO2 decreased at T3 and T5,and se-rum CC-16 and IL-6 levels decreased at T4 in the esketamine group(all P<0.05).Compared with the control group,total propofol and remifentanil consumption were lower in the esketamine group(both P<0.05).No significant differences were found in vomiting,psychiatric adverse events,or PPCs between the two groups(all P>0.05),but the esketamine group had lower incidences of nausea and respiratory depression than the control group(both P<0.05).Conclusion Subanes-thetic-dose esketamine improves pulmonary respiratory mechanics and mitigates pulmonary inflammatory response in obese patients undergoing laparoscopic surgery in the Trendelenburg position,but it does not reduce PPCs.关键词
艾司氯胺酮/肺损伤/肥胖/Trendelenburg体位/腹腔镜手术Key words
esketamine/lung injury/obesity/Trendelenburg position/laparoscopy分类
临床医学引用本文复制引用
孙健,秦海倩,程莉,李德东,卢悦淳..亚麻醉剂量艾司氯胺酮对Trendelenburg体位腹腔镜手术肥胖患者肺损伤的影响[J].山东医药,2025,65(10):53-57,62,6.基金项目
天津市教委科研计划项目(2020KJ174) （2020KJ174）
天津麻醉科研发展计划项目(TJMZ2022-03). （TJMZ2022-03）
