摘要
目的:探讨在胸腔镜肺叶切除术中应用艾司氯胺酮联合前锯肌平面(SAP)阻滞的效果。方法:选取2023年1月—2024年12月在鄂州市鄂钢医院收治的84例行胸腔镜肺叶切除术的患者作为研究对象。随机分为SAP阻滞组(对照组)与艾司氯胺酮联合SAP阻滞组(联合组),每组各42例。麻醉诱导前,两组均予以SAP阻滞;于切皮前,联合组接受的干预为:以每小时0.25 mg·kg^(-1)·h^(-1)的速率持续静脉泵注艾司氯胺酮,直至术前30 min结束。对照组则以相同方式泵注生理盐水作为对照;两组其余麻醉镇痛方案相同。于术后2 h、8 h、24 h和48 h,记录患者疼痛视觉模拟(VAS)评分;记录患者术中和术后镇痛情况;术前1 d和术后2 d,分别记录患者15项恢复质量(QoR-15)评分;于术前及术后24 h,对患者血清C反应蛋白(CRP)和肿瘤坏死因子-α(TNF-α)进行测定。结果:与对照组比较,在术后2 h、8 h和24 h时,联合组VAS评分均更低,差异有统计学意义(P<0.05);且联合组术中丙泊酚用量、瑞芬太尼用量和术后舒芬太尼用量减少,差异均有统计学意义(P<0.05);在术后1 d和2 d时与对照组相比较,观察组QoR-15评分更高,差异有统计学意义(P<0.05)。在术后24 h,观察组血清CRP与TNF-α的升幅均低于对照组,差异具有统计学意义(P<0.05)。结论:在胸腔镜肺叶切除术中实施艾司氯胺酮联合SAP阻滞,能够获得更完善的术后镇痛和炎症反应抑制,提高患者术后恢复质量。
Objective:To investigate the effect of esketamine combined with serratus anterior plane(SAP)block on postoperative analgesia and inflammatory response in patients undergoing thoracoscopic lobectomy.Method:84 patients who underwent thoracoscopic lobectomy in the Ezhou Egang Hospital From January 2023 to December 2024 were selected for study.The patients were randomly divided into SAP block group(control group)and esketamine combined with SAP block group(combined group),with 42 cases in each group.Before induction of anesthesia,both groups were given SAP block.Before skin incision,the combined group was given esketamine pumping at 0.25 mg·kg^(-1)·h^(-1)until 30 min before operation,and the control group was given normal saline pumping accordingly.The remaining anesthesia and analgesia regimens of the two groups were the same.The visual analogue scale(VAS)scores were recorded at 2 h,8 h,24 h and 48 h after the operation.The intraoperative and postoperative analgesia of patients were recorded.The Quality of Recovery-15(QoR-15)scores were recorded at 1 day before operation and 2 days after operation respectively.Before the operation and 24 h after operation,the serum C-reactive protein(CRP)and tumor necrosis factor-α(TNF-α)were measured.Result:Compared with the control group,the VAS scores of the combined group were lower at 2 h,8 h and 24 h after operation,with statistically significant differences(P<0.05),the intraoperative dosage of propofol,remifentanil and postoperative dosage of sufentanil in the combined group were reduced,with statistically significant differences(P<0.05).Compared with the control group at 1 day and 2 d after the operation,the QoR-15 score of the observation group was higher,with statistically significant differences(P<0.05).At the 24 h postoperative mark,serum CRP and TNF-αlevels were lower in the observation group than those in the control group,with statistically significant differences(P<0.05).Conclusion:The application of esketamine combined with SAP block in thoracoscopic lobectomy can enhance the postoperative analgesic effect,reduce the inflammatory response and improve the quality of postoperative recovery.
作者
杨俊
YANG Jun(Ezhou Egang Hospital,Ezhou 436000,China)
出处
《中外医学研究》
2025年第33期13-16,共4页
CHINESE AND FOREIGN MEDICAL RESEARCH
关键词
胸腔镜
肺叶切除术
前锯肌平面阻滞
艾司氯胺酮
镇痛
炎症反应
Thoracoscopy
Lobectomy
Anterior serratus plane block Esketamine
Analgesia
Inflammatory response
