艾司氯胺酮对胸腔镜肺叶切除术后疼痛及炎症应激的影响

Effects of esketamine on pain and inflammation stress in patients after thoracoscopic lobectomy

目的探讨艾司氯胺酮对胸腔镜肺叶切除术后疼痛及炎症应激的影响。方法选择全身麻醉下行胸腔镜肺叶切除术患者64例,男27例,女37例,年龄30~65岁,BMI 18~30 kg/m^(2),美国麻醉医师协会分级Ⅰ~Ⅱ级。采用随机数字表法将患者分为两组:舒芬太尼组(C组)和艾司氯胺酮复合舒芬太尼组(S组),每组32例。两组患者麻醉诱导及术中维持用药方案一致,术后C组采用舒芬太尼镇痛,S组采用艾司氯胺酮复合舒芬太尼镇痛。记录两组患者一般情况,术后6 h(T1)、12 h(T2)、24 h(T3)、48 h(T4)、72 h(T5)各时间点静息视觉模拟评分法(VAS)评分,术前1 d(T0)及术后72 h(T5)时间点白细胞计数、中性粒细胞比率和C反应蛋白(CRP)水平,比较两组患者镇痛泵有效按压次数、补救镇痛情况、不良反应及术后慢性疼痛(CPSP)发生率。结果两组患者一般情况、T0时刻白细胞计数、中性粒细胞比率和CRP水平比较差异无统计学意义(P>0.05);S组T1、T2、T3时刻静息VAS评分明显低于C组(P<0.05),而T4、T5时刻两组静息VAS评分差异无统计学意义(P>0.05);与C组相比,S组在T5时刻的白细胞计数、CRP水平及总不良反应发生率均明显降低(P<0.05);两组患者镇痛泵有效按压次数、补救镇痛情况及术后慢性痛发生率差异均无统计学意义(P>0.05)。结论艾司氯胺酮复合舒芬太尼镇痛能够减轻胸腔镜肺叶切除患者术后早期疼痛,降低炎症应激水平,且不良反应发生率较低,有助于加速患者康复。

Objective To investigate the effects of esketamine on postoperative pain and inflammation stress after thoracoscopic lobectomy.Methods A total of sixty-four patients with general anesthesia undergoing thoracoscopic lobectomy were selected.There were 27 males and 37 females,aged 30-65 years old,with BMI of 18-30 kg/m^(2) and ASA grade ofⅠ-Ⅱ.Patients were divided into two groups by random digital table:the sufentanil group(group C)and the esketamine combined with sufentanil group(group S),with 32 cases in each group.The anesthesia induction and maintenance medication regiment of the two groups were consistent.After operation,sufentanil was used for analgesia in the group C,esketamine combined with sufentanil for analgesia in the group S.The general condition of the two groups were recorded,including the resting Visual Analogue Scale(VAS)score at six hours(T1),12 hours(T2),24 hours(T3),48 hours(T4)and 72 hours(T5)after operation,the white blood cell count,neutrophil ratio and C-reactive protein(CRP)levels at 1 day before operation(T0)and 72 hours(T5)after operation.The number of effective analgesic pump compression,remedial analgesia,adverse reactions and the incidence of chronic post-surgical pain(CPSP)were compared between the two groups.Results There was no significant difference in general condition,preoperative white blood cell count,neutrophil ratio and level of CRP between the two groups(P>0.05).The resting VAS pain score in the group S was significantly lower than that of the group C at T1,T2 and T3(P<0.05),while there was no significant difference in resting VAS pain scores at T4 and T5 between the two groups(P>0.05).Compared with the group C,the white blood cell count,level of CRP and the incidence of total adverse reactions in the group S were significantly decreased at T5(P<0.05).There was no significant difference between the two groups in effective pressing times of analgesic pump,remedial analgesia and incidence of chronic post-surgical pain(P>0.05).Conclusion Esketamine combined with sufentanil can relieve the early postoperative pain and reduce the level of inflammatory stress in patients undergoing thoracoscopic lobectomy,reduce inflammatory stress level,and have a low incidence of adverse reactions,which is conducive to accelerating the recovery of patients.