艾司氯胺酮对老年患者胸腔镜下肺癌根治术后呼吸抑制的影响

Effects of esketamine on respiratory depression after radical thoracoscopic resection of lung cancer in elderly patients

目的 探讨艾司氯胺酮对老年患者胸腔镜下肺癌根治术后呼吸抑制的影响。方法 选取全身麻醉胸腔镜下行肺癌根治术的老年患者60例,按随机数字表法分为观察组(30例)和对照组(30例)。术后行患者自控静脉镇痛,观察组镇痛配方为艾司氯胺酮0.2 mg/kg+舒芬太尼1.3μg/kg+地塞米松5 mg+右美托咪定100μg,对照组镇痛配方为舒芬太尼1.5μg/kg+地塞米松5 mg+右美托咪定100μg。记录患者术后4、8、24、48 h静息和运动时疼痛视觉模拟量表(VAS)评分和Ramsay镇静评分;采用蒙特利尔认知评估量表(MoCA)于术前1 d,术后1、3 d评估认知功能;记录手术时间、住院时间和补救镇痛率及患者的术后并发症情况。结果 观察组住院时间短于对照组(P<0.05)。术后48 h内2组静息时疼痛VAS评分差无统计学意义。术后4、8、24、48 h观察组运动时疼痛VAS评分明显低于对照组(P<0.05)。术后48 h内观察组患者Ramsay评分高于对照组(P<0.05)。2组患者MoCA评分差异均无统计学意义。观察组补救镇痛率、低血压、头晕、呼吸抑制发生率低于对照组(P<0.05),2组恶心呕吐发生率差异无统计学意义。结论 艾司氯胺酮可为老年患者胸腔镜下肺癌手术术后提供更好的镇痛、镇静效果,减少住院时间,降低术后呼吸抑制、低血压和头晕发生率。

Objective To investigate the effect of esketamine on respiratory depression after radical thoracoscopic resection of lung cancer in elderly patients.Methods Sixty elderly patients undergoing radical operation of lung cancer under general anesthesia were selected and divided into the observation group(30 cases)and the control group(30 cases)according to random number table method.Patient-controlled intravenous analgesia was performed after surgery.The analgesic formula in the observation group was esketamine 0.2 mg/kg+Sufentanil 1.3μg/kg+dexamethasone 5 mg+dexmedetomidine 100μg,and the analgesic formula of the control group was Sufentanil 1.5μg/kg+dexamethasone 5 mg+dexmedetomidine 100μg.Visual analog scale(VAS)at rest and during exercise and Ramsay sedation score were recorded at 4,8,24 and 48 h after surgery.The Montreal Cognitive Assessment Scale(MoCA)was used to assess cognitive function 1 day before surgery and 1 and 3 days after surgery.The duration of operation,length of hospital stay,rate of remedial analgesia and postoperative complications were recorded.Results The hospitalization time of the observation group was shorter than that of the control group(P<0.05).There was no significant difference in resting VAS score within 48 h after surgery between the two groups.The VAS scores at 4,8,24 and 48 h after operation were significantly lower in the observation group than those of the control group(P<0.05).Ramsay scores within 48 h after surgery were higher in the observation group than those in the control group(P<0.05).There were no significant differences in MoCA scores between the two groups.Incidence rates of analgesia,hypotension,dizziness and respiratory depression were lower in the observation group than those in the control group(P<0.05),and there were no significant differences in incidences of nausea and vomiting between the two groups.Conclusion Esketamine can provide better analgesia and sedation after thoracoscopic lung cancer surgery in elderly patients,reduce hospital stay,and reduce the incidence of postoperative respiratory depression,hypotension and dizziness.