亚麻醉剂量艾司氯胺酮对胸腔镜手术后阿片类药物镇痛消耗量的影响

Effects of subanesthetic dose of esketamine on opioid consumption after thoracoscopic surgery

目的:探讨术中持续静脉输注亚麻醉剂量艾司氯胺酮对胸腔镜手术患者术后阿片类药物镇痛消耗量的影响。方法:选取郑州大学第一附属医院2020年12月至2021年12月择期胸腔镜肺部手术患者71例,年龄18~70岁,男32例,女39例;美国麻醉医师协会(ASA)分级Ⅰ或Ⅱ级,体质指数(BMI)18.5~30.0 kg/m^(2)。采用随机数字表法分为3组:(1)对照组(C组, n=24):术中持续静脉输注等速率生理盐水;(2)亚麻醉剂量艾司氯胺酮0.125 mg·kg^(-1)·h^(-1)组(ES1组, n=23):术中持续静脉输注艾司氯胺酮0.125 mg·kg^(-1)·h^(-1);(3)亚麻醉剂量艾司氯胺酮0.250 mg·kg^(-1)·h^(-1)组(ES2组, n=24):术中持续静脉输注艾司氯胺酮0.250 mg·kg^(-1)·h^(-1)。主要观察指标为3组患者术后24、48 h内患者氢吗啡酮总消耗量;次要观察指标为3组患者术后气管导管拔出时间、麻醉复苏室(PACU)停留时间、术后首次进食时间,以及术后24 h内不良反应发生情况。 结果:C组、ES1组和ES2组患者术后24 h氢吗啡酮消耗量分别为(5.4±1.0)、(4.5±1.5)、(4.0±0.8)mg,术后48 h氢吗啡酮消耗量分别为(9.7±2.2)、(9.0±3.0)、(7.7±1.8)mg;与C组相比,ES1组和ES2组患者术后24 h氢吗啡酮消耗量均减少(均 P<0.05)。C组患者气管导管拔除时间、PACU停留时间、术后首次进食时间分别为(23±10)min、(70±12)min、(17±3)h,ES1组分别为(22±4)min、(69±11)min、(14±5)h,ES2组分别为(16±8)min、(58±12)min、(14±3)h;与C组和ES1组相比,ES2组气管导管拔除时间、PACU停留时间均缩短(均 P<0.05);与C组相比,ES1组、ES2组术后首次进食时间缩短(均 P<0.05)。3组患者术后24 h不良反应发生率比较差异均无统计学意义(均 P>0.05)。 结论:术中持续静脉输注亚麻醉剂量艾司氯胺酮0.250 mg·kg^(-1)·h^(-1)可显著减少术后阿片类药物消耗量,促进患者转归。

Objective To investigate the effect of continuous intravenous infusion of subanesthetic dose of esketamine intraoperatively on postoperative opioid consumption in patients undergoing thoracoscopic surgery.Methods A total of 71 patients with elective thoracoscopic lung surgery in the First Affiliated Hospital of Zhengzhou University from December 2020 to December 2021 were selected.Patients who were classified as gradeⅠorⅡby the American Society of Anesthesiologists(ASA)and aged 18-70 years were included,including 32 males and 39 females,with a body mass index(BMI)of 18.5-30.0 kg/m2.The patients were randomly divided into three groups:(1)Control group(group C,n=24):continuous intravenous infusion of normal saline at the same rate during surgery;(2)Subanesthetic dose of esketamine 0.125 mg·kg^(-1)·h^(-1) group(group ES1,n=23):continuous intravenous infusion of esketamine at a rate of 0.125 mg·kg^(-1)·h^(-1) during surgery;(3)Subanesthetic dose of esketamine 0.250 mg·kg^(-1)·h^(-1) group(group ES2,n=24):continuous intravenous infusion of esketamine at a rate of 0.250 mg·kg^(-1)·h^(-1) during surgery.The main outcome measures were the total consumptions of hydromorphone of 3 groups within 24 and 48 hours after surgery.The secondary outcome measures were the extubation time,length of postanesthesia care unit(PACU)stay,the time of first feeding,and the incidences of adverse effects within 24 h after surgery in 3 groups.Results The 24 h postoperative consumption of hydromorphone in group C,ES1 and ES2 was(5.4±1.0)mg,(4.5±1.5)mg and(4.0±0.8)mg,respectively.Likewise,the 48 h postoperative consumption of hydromorphone was(9.7±2.2)mg,(9.0±3.0)mg and(7.7±1.8)mg,respectively.Compared with group C,the 24 h postoperative hydromorphone consumptions were significantly reduced in group ES1 and ES2(both P<0.05).The extubation time,length of PACU stay and the time of first feeding after surgery in group C were(23±10)min,(70±12)min,(17±3)h,in group ES1 were(22±4)min,(69±11)min,(14±5)h,in group ES2 were(16±8)min,(58±12)min,(14±3)h,respectively.Compared with group C and group ES1,both of the extubation time and length of PACU stay were shortened in group ES2(both P<0.05).Compared with group C,the first postoperative feeding time of group ES1 and ES2 was shortened(both P<0.05).There were no differences in the incidences of adverse effects at postoperative 24 h among 3 groups(all P>0.05).Conclusion Continuously intravenous infusion of subanesthetic esketamine at a rate of 0.250 mg·kg^(-1)·h^(-1) can significantly reduce the postoperative opioid consumption and improve the patient′s outcomes.