艾司氯胺酮联合不同剂量右美托咪定对肺癌手术患者的镇痛效果研究

Analgesic effects of esketamine combined with different doses of dexmedetomidine in lung cancer surgery

目的观察艾司氯胺酮联合不同剂量右美托咪定对肺癌手术患者的镇痛效果。方法本文为随机对照试验。病例纳入时间为2020年8月至2022年1月,研究对象为开封市肿瘤医院收治的128例肺癌患者,应用抽签法将患者均分为两组。将采用艾司氯胺酮辅助麻醉诱导及0.5μg(/kg·h)右美托咪定维持麻醉的64例患者列为常规组,其中男45例,女19例,年龄(49.12±5.33)岁;将采用艾司氯胺酮辅助麻醉诱导及0.3μg(/kg·h)右美托咪定维持麻醉的64例患者列为低剂量组,其中男44例,女20例,年龄(48.77±5.25)岁。比较两组患者围手术期体征指标变化情况、术后苏醒质量、认知功能及麻醉相关不良反应。统计学方法采用独立样本t检验、配对t检验、χ^(2)检验。结果麻醉10 min后,低剂量组的心率(HR)[(73.33±10.45)次/min比(72.16±10.23)次/min]、平均动脉压(MAP)[(102.44±20.27)mmHg(1 mmHg=0.133 kPa)比(102.33±20.46)mmHg]与常规组比较差异均无统计学意义(均P>0.05);术毕,低剂量组的HR[(76.22±5.35)次/min比(74.22±10.35)次/min]、MAP[(104.77±8.24)mmHg比(103.25±8.31)mmHg]与常规组比较差异均无统计学意义(均P>0.05)。术后,低剂量组视觉模拟评分法(VAS)评分与常规组[(3.36±1.25)分比(2.77±1.04)分]比较差异无统计学意义(P>0.05);低剂量组的睁眼时间[(10.27±2.11)min比(12.77±2.36)min]、拔管时间[(11.75±2.58)min比(13.49±2.49)min]均短于常规组,苏醒后Ramsay镇静评分低于常规组[(4.42±1.45)分比(5.25±1.33)分],差异均有统计学意义(均P<0.05);低剂量组的简易智力检查量表(MMSE)评分[(25.64±5.28)比(22.33±5.46)分]、蒙特利尔认知评估量表(MoCA)评分[(25.79±5.18)分比(22.69±5.33)分]均高于常规组(均P<0.05)。低剂量组的麻醉相关不良反应发生率低于常规组[4.69%(3/64)比15.63%(10/64)],差异有统计学意义(χ^(2)=6.556,P=0.010)。结论艾司氯胺酮辅助麻醉诱导及低剂量右美托咪定维持麻醉可产生理想的镇痛效果,并维持肺癌患者围手术期体征稳定,对促进患者术后苏醒、避免认知功能损伤有积极意义,安全性高。

Objective To observe the analgesic effects of esketamine combined with different doses of dexmedetomidine in lung cancer surgery.Methods This was a randomized controlled trial.From August 2020 to January 2022,128 patients with lung cancer admitted to Kaifeng Cancer Hospital were divided into two groups by the lottery method.Sixty-four patients receiving esketamine assisted anesthesia induction and maintenance of anesthesia with 0.5μg/(kg·h)dexmedetomidine were classified as the routine group,including 45 males and 19 females,aged(49.12±5.33)years.Sixty-four patients receiving esketamine assisted anesthesia induction and maintenance of anesthesia with 0.3μg/(kg·h)dexmedetomidine were classified as the low-dose group,including 44 males and 20 females,aged(48.77±5.25)years.The changes of perioperative signs,postoperative recovery quality,cognitive function,and anesthesia-related adverse reactions were compared between the two groups.The statistical methods used were independent sample t test,paired t test,and χ^(2) test.Results Ten min after anesthesia(T1),the heart rates(HR)and mean arterial pressures(MAP)of the low-dose group and the routine group[(73.33±10.45)beats/min vs.(72.16±10.23)beats/min,(102.44±20.27)mmHg(1 mmHg=0.133)vs.(102.33±20.46)mmHg]showed no statistically significant differences(both P>0.05).At the end of surgery(T2),the HR and MAP of the low-dose group and the routine group[(76.22±5.35)beats/min vs.(74.22±10.35)beats/min,(104.77±8.24)mmHg vs.(103.25±8.31)mmHg]showed no statistically significant differences(both P>0.05).After surgery,there was no statistically significant difference in the Visual Analogue Scale(VAS)score between the low-dose group and the routine group[(3.36±1.25)points vs.(2.77±1.04)points](P>0.05);the eye opening time[(10.27±2.11)min vs.(12.77±2.36)min]and extubation time[(11.75±2.58)min vs.(13.49±2.49)min]in the low-dose group were shorter than those in the routine group,and the Ramsay sedation score after recovery was lower than that in the routine group[(4.42±1.45)points vs.(5.25±1.33)points],with statistically significant differences(all P<0.05).After surgery,the scores of Mini-Mental State Examination(MMSE)[(25.64±5.28)points vs.(22.33±5.46)points]and Montreal Cognitive Assessment Scale(MoCA)[(25.79±5.18)points vs.(22.69±5.33)points]in the low-dose group were higher than those in the routine group(both P<0.05).The incidence of anesthesia-related adverse reactions in the low-dose group was lower than that in the routine group[4.69%(3/64)vs.15.63%(10/64)],with a statistically significant difference(χ^(2)=6.556,P=0.010).Conclusion Esketamine assisted anesthesia induction and maintenance of anesthesia with low-dose dexmedetomidine can produce ideal analgesic effect,and maintain the stability of perioperative signs in lung cancer patients,which has positive significance in promoting their postoperative recovery and avoiding the cognitive function injury,with high safety.