艾司氯胺酮对保留自主呼吸全身麻醉单孔胸腔镜手术患者呼吸的影响

Effect of esketamine on respiration during single-port thoracoscopic surgery under general anesthesia with preserved spontaneous respiration

目的探讨艾司氯胺酮对保留自主呼吸全身麻醉下行单孔胸腔镜手术患者呼吸、并发症、急性期炎性因子的影响。方法选择择期全身麻醉下保留自主呼吸单孔胸腔镜手术患者90例,年龄16~74岁,BMI 18~28 kg/m^(2),ASAⅠ-Ⅱ级。采用随机数字表法分为观察组(E组,n=45)和对照组(C组,n=45)。E组患者诱导时给予艾司氯胺酮0.5 mg/kg,切皮前再次给予0.25 mg/kg。C组患者诱导时给予舒芬太尼0.15μg/kg。两组患者余诱导、维持方案一致。记录患者入室(T_(0))、打开胸膜前(T_(1))、打开胸膜后15 min(T_(2))、打开胸膜后30 min(T_(3))、拔除喉罩前(T_(4))的SpO_(2)、PaCO_(2)、PaO_(2)。于T_(0)和术后24 h(T_(5))抽取肘正中静脉血3 mL并检测TNF-α、IL-6浓度;记录自主呼吸恢复时间、喉罩拔除时间、呼吸干预、术中体动发生情况;记录术后恶心呕吐、精神症状、术中知晓发生情况和总住院时间。结果与C组比较,E组患者T1时刻PaO_(2)明显降低,PaCO_(2)明显升高(P<0.01),T_(2)时刻PaO_(2)明显升高,PaCO_(2)明显降低(P<0.01),喉罩置入后自主呼吸恢复时间明显缩短,术中呼吸干预次数明显减少,且以减弱呼吸为主(P<0.01)。与T_(0)时刻比较,T_(5)时刻TNF-α、IL-6浓度均升高,且C组升高程度高(P<0.01);喉罩拔除时间、并发症、住院时间组间无明显差异。结论艾司氯胺酮可减少保留自主呼吸全身麻醉下行单孔胸腔镜手术患者术中的呼吸抑制,缩短患者自主呼吸恢复时间,维持自主呼吸期间呼吸稳定性,减轻急性期炎性反应。

Objective To investigate the effects of esketamine on respiration,complications and acute phase inflammatory factors in patients undergoing single-port thoracoscopic surgery under general anesthesia with preserved spontaneous respiration.Methods Ninety patients,aged 16~74 years,BMI 18~28 kg/m^(2),ASA physical statusⅠorⅡ,who were scheduled to undergo single-port thoracoscopic surgery under general anesthesia were selected.Patients were randomly divided into two groups by random number table:esketamine group(group E,n=45)and control group(group C,n=45).Esketamine 0.5 mg/kg was given for induction of anesthesia,and 0.25 mg/kg again before cutting skin.In group C,sufentanilwas given at 0.15μg/kg for induction of anesthesia.Other anesthesia induction and maintenance durgs in both groups were the same.SP0_(2),PaCO_(2) and PaO_(2) were recorded at the patient's entrance(T_(0)),before pleuraopening(T_(1)),15 min after pleuraopening(T_(2)),30 min after pleuraopening(T_(3)),and beforelaryngeal mask removal(T_(4)).3 mL of blood was extracted from themedian cubital vein at T_(0)and 24 h after surgery(T_(5))todetect the concentrations of TNF-αand IL-6.The length of spontaneous respiration recovery and laryngeal mask removal,the number of respiratory intervention,the incidence of body movement during operation,nausea,vomiting,psychiatric symptom,awareness,the length of hospital stay was recorded.Results Compared with group C,PaO_(2)was significantly decreased and PaCO_(2)was significantly increased in group E at T_(1),PaO_(2)was significantly increased and PaCO_(2)was significantly decreased at T2(P<0.01).Compared with group C,the length of spontaneous respiration recovery was significantly shortened and the number of respiratory intervention was significantly decreased in group E(P<0.01).Compared with group C,the concen-trations of TNF-αand IL-6 in venous blood in group E at T_(5) was significantly decreased(P<0.01).There were no significant difference in the length of laryngeal mask removal,and the incidenceofcomplications,hospitalstay between the two groups.Conclusion Esketamine reducesintraoperative respiratory depression,shortens spontaneous respiration recovery,maintains respiratory stability and reduces acute inflammatory response in patients under general anesthesia with preserved spontaneous respiration for single-port thoracoscopic surgery.