艾司氯胺酮联合竖脊肌平面阻滞对胸腔镜手术患者术后早期恢复质量的影响

Effects of esketamine combined with erector spinae block on the quality of early postoperative recovery in patients undergoing thoracoscopic surgery

目的探讨艾司氯胺酮联合竖脊肌平面阻滞(ESPB)对胸腔镜肺部手术患者术后早期恢复质量的影响。方法选择2022年5月至2023年7月行胸腔镜肺部手术(胸腔镜下肺癌根治术、胸腔镜下肺叶或肺段切除术)患者90例,男47例,女43例,年龄18~64岁,BMI 18~25 kg/m^(2),ASAⅠ或Ⅱ级。采用随机数字法将患者分为两组:ESPB组(C组)和艾司氯胺酮联合ESPB组(D组),每组45例。两组患者完成超声引导下ESPB,随后C组采用舒芬太尼行麻醉诱导和患者自控静脉镇痛(PCIA);D组用艾司氯胺酮行麻醉诱导、麻醉维持和术后PCIA。记录术中麻醉药物用量、术后1、6、12、24、48 h患者活动时NRS疼痛评分、术后24 h内PCIA按压次数、术后补救镇痛次数、麻醉苏醒时间、术后2 d内术后恶心、呕吐及艾司氯胺酮有关不良反应的发生情况。术前1 d、术后2 d采用40项恢复质量量表(QoR-40)评分评估患者恢复质量。术前1 d及出院时采用医院焦虑-抑郁量表(HADS)评估患者焦虑、抑郁情绪。结果与C组比较,D组术中丙泊酚、瑞芬太尼用量明显减少,术后恶心呕吐发生率明显降低,术后2 d QoR-40评分明显升高,出院时HADS评分明显降低(P<0.05)。结论艾司氯胺酮联合ESPB用于胸腔镜肺部手术患者安全有效,围术期镇痛完善,不良反应少,患者早期恢复质量较高,为此类手术提供一种新的麻醉选择。

Objective To investigate the effect of esketamine combined with erector spinae plane block(ESPB)on the quality of early postoperative recovery in patients undergoing thoracoscopic pulmonary surgery.Methods Ninety patients who underwent thoracoscopic lung surgery(thoracoscopic radical resection of lung cancer,thoracoscopic lobectomy or segmentectomy)from May 2022 to July 2023 were selected,47 males and 43 females,aged 18-64 years,BMI 18-25 kg/m^(2),ASA physical statusⅠorⅡ.According to random number table method,the patients were divided into two groups:the ESPB group(group C)and the esketamine combined with ESPB group(group D),45 patients in each group.Patients in the two groups completed ultrasound-guided ESPB,followed by sufentanil anesthesia induction and patient-controlled intravenous analgesia(PCIA)in group C,while esketamineanesthesia induction,maintenance,and PCIA in group D.The intraoperative dosage of anesthetics,numerical rating scale(NRS)score during activity 1 hour,6,12,24,and 48 hours after operation,the number of PCIA compressions within 24 hours after operation,the number of rescue analgesia after operation,the recovery time of anesthesia,the incidence of postoperative nausea and vomiting within 2 days after operation and the adverse reactions related to esketamine were recorded.The 40-item recovery quality scale(QoR-40)score was used to evaluate the quality of recovery of patients 1 day before operation and 2 days after operation.The hospital anxiety and depression scale(HADS)was used to assess patients anxiety and depression 1 day before surgery and at discharge.Results Compared with group C,the dosage of propofol and remifentanil intraoperatively,the incidence of postoperative nausea and vomiting were decreased(P<0.05),the QoR-40 score was increased 2 days after operation,HADS score at discharge was decreased in group D(P<0.05).Conclusion Esketamine combined with ESPB is safe and effective for patients undergoing thoracoscopic lung surgery.The perioperative analgesia is perfect,the adverse reactions are few,and the quality of early recovery is high,which provides a new anesthesia choice for such surgery.