艾司氯胺酮用于老年胸腔镜手术患者竖脊肌平面阻滞的临床效果观察

Effect of esketamine on erector spinae plane block in elderly patients undergoing thoracoscopic surgery

目的探讨艾司氯胺酮用于竖脊肌平面阻滞(erector spinae plane block,ESPB)在老年胸腔镜手术患者的临床应用效果。方法选择徐州市肿瘤医院择期拟行胸腔镜手术的老年患者152例,年龄65岁以上,BMI 18.5~30.0 kg/m^(2),ASA分级Ⅰ、Ⅱ级,采用随机数字表法分为两组(每组76例):艾司氯胺酮联合罗哌卡因ESPB组(A组)和罗哌卡因ESPB组(L组)。两组患者均于全麻诱导前行超声引导下ESPB,A组患者注入0.375%罗哌卡因150 mg+艾司氯胺酮0.5 mg/kg+生理盐水,共40 ml;L组患者注入0.375%罗哌卡因150 mg+生理盐水,共40 ml。采用简易精神状态检查(Mini-mental State Examination,MMSE)评分评估患者基础认知状态,记录两组患者术前1 d、术后1 d、术后2 d、术后3 d和术后7 d MMSE评分情况,术中丙泊酚和瑞芬太尼的用量、手术时间及苏醒时间(手术结束至气管导管拔除时间),术后0~6 h、6~12 h、12~24 h、24~48 h患者自控静脉镇痛(patient-controlled intravenous analgesia,PCIA)有效按压次数,术后6、12、24、48 h静息和咳嗽时VAS疼痛评分,术后3 d内和术后7 d患者术后谵妄(postoperative delirium,POD)发生率。结果与L组比较:A组术中丙泊酚和瑞芬太尼用量减少(P<0.05),术后0~6 h、6~12 h、12~24 h PCIA有效按压次数减少(P<0.05),术后6、12、24 h咳嗽时VAS疼痛评分降低(P<0.05),术后1 d MMSE评分升高(P<0.05),术后3 d内POD发生率降低(P<0.05)。两组患者其余指标比较差异无统计学意义(P>0.05)。结论艾司氯胺酮用于ESPB可降低术后3 d内POD发生率,减少老年患者胸腔镜手术术中丙泊酚和瑞芬太尼用量,术后镇痛效果良好。

Objective To investigate the clinical effect of esketamine on erector spinae plane block(ESPB)in elderly patients un-dergoing thoracoscopic surgery.Methods A total of 152 elderly patients,aged over 65 years,body mass index(BMI)18.5‒30.0 kg/m^(2),American Society of Anesthesiologists(ASA)ⅠorⅡ,who were scheduled for thoracoscopic surgery in Xuzhou Cancer Hospital were se-lected.According to the random number table method,they were divided into two groups(n=76):an esketamine combined with ropivacaine for ESPB group(group A)and a ropivacaine for ESPB group(group L).Patients in both groups underwent ultrasound-guided ESPB before anesthesia induction.Patients in group A were injected with 0.375%ropivacaine 150 mg+esketamine 0.5 mg/kg+normal saline in 40 ml,while those in group L were injected with 0.375%ropivacaine 150 mg+normal saline in 40 ml.The Mini-Mental State Examination(MMSE)scores were used to assess patients'basic cognitive condition.MMSE scores were recorded 1 d before surgery,and at postopera-tive 1,2,3 d and 7 d.The intraoperative dosage of propofol and remifentanil,operation time and recovery time(from the end of operation to the time of tracheal catheter removal)were recorded.The effective times of patient-controlled intravenous analgesia(PCIA)compression at postoperative 0‒6 h,6‒12 h,12‒24 h and 24‒48 h,Visual Analogue Scale(VAS)scores at rest and on coughing at postoperative 6,12,24 h and 48 h,and the incidence of postoperative delirium(POD)within postoperative 3 d and 7 d were recorded.Results Compared with group L,group A showed significantly decreased consumption of propofol and remifentanil(P<0.05),reduced effective times of PCIA compression at postoperative 0‒6 h,6‒12 h and 12‒24 h(P<0.05),decreased VAS scores on coughing at postoperative 6,12 h and 24 h(P<0.05),increased MMSE scores at postoperative 1 d(P<0.05),and reduced incidence of POD within postoperative 3 d(P>0.05).There was no difference in other indicators between the two groups(P>0.05).Conclusions Application of esketamine in ESPB can reduce the incidence of delirium within 3 d after surgery,significantly reduce the consumption of propofol and remifentanil in elderly patients with thoracoscopic surgery,with good postoperative analgesic effect.