小剂量艾司氯胺酮对胸腔镜患者术后镇痛及炎症因子的影响
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篇名: 小剂量艾司氯胺酮对胸腔镜患者术后镇痛及炎症因子的影响
TITLE: Effects of low-dose esketamine on analgesia and inflammatory factors after thoracoscopic surgery
摘要: 目的 观察小剂量艾司氯胺酮用于胸腔镜术后镇痛的效果及其对炎症因子的影响。方法选取2021年10月-2022年3月于我院接受胸腔镜肺叶切除术的患者120例,按随机数字表法分为小剂量组(A组)、常规剂量组(B组)、生理盐水组(C组),每组40例。所有患者均接受传统全身静脉麻醉,A、B组患者术中分别应用小剂量或常规剂量(0.2或0.5mg/kg)盐酸艾司氯胺酮注射液辅助麻醉,C组患者静脉滴注生理盐水。比较3组患者术后0、6、24、48h时静息状态下的视觉模拟法(VAS)评分和术后24h内的舒芬太尼消耗量;比较其术前30min、术后24h的白细胞计数(WBC)、中性粒细胞百分比、C反应蛋白(CRP)、肿瘤坏死因子α(TNF-α),白细胞介素1(IL-1)、IL-6水平;比较其术前和术后0、1、2d的匹兹堡睡眠质量指数(PSQI)、贝克忧郁量表(BDI)评分,并记录不良反应发生情况。结果A、B组患者术后0、6、24h时静息状态下的VAS评分、术后24h内的舒芬太尼消耗量均显著低于C组,且A组术后6h时静息状态下的VAS评分显著低于B组(P<0.05)。3组患者术后24h的WBC、中性粒细胞百分比、CRP、TNF-α、IL-1、IL-6水平均较术前30min显著上升,A、B组患者术后24h的上述指标均显著低于C组(P<0.05)。A、B组患者术后0、1、2d的PSQI评分和BDI评分均显著低于C组,且A组患者术后0d的BDI评分显著低于B组(P<0.05)。A、B、C组不良反应总发生率分别为5.0%、10.0%、17.5%,差异无统计学意义(P>0.05)。结论小剂量艾司氯胺酮用于胸腔镜手术患者术后镇痛的早期效果显著,可降低其术后炎症因子水平,改善其睡眠质量和抑郁状态,且安全性较高。
ABSTRACT: OBJECTIVE To observe the effects of low-dose esketamine on analgesia and inflammatory factors after thoracoscopic surgery. METHODS Totally 120 patients who underwent thoracoscopic lobectomy in our hospital from October 2021 to March 2022 were selected and randomly divided into low-dose group (group A), conventional-dose group (group B), normal saline group (group C) by using the random number table method, with 40 patients in each group. All the patients were anesthetized with traditional general intravenous anesthesia, group A and B were anesthetized with low dose or normal dose (0.2 or 0.5 mg/kg) of Esketamine hydrochloride injection, and group C was given normal saline intravenously. The visual analog scale (VAS) score 0, 6, 24, 48 h after operation and the consumption of sufentanil 24 h after operation were compared among 3 groups. The levels of white blood cell count (WBC), neutrophil percentage, C-reactive protein (CRP), tumor necrosis factor-α (TNF-α), interleukin-1 (IL-1) and IL-6 were compared 30 min before and 24 h after surgery. The Pittsburgh sleep quality index (PSQI) score and the Beck depression inventory (BDI) score were compared before operation and 0, 1, 2 d after operation, and the occurrence of adverse reaction was also recorded. RESULTS At 0, 6 and 24 h after operation, VAS scores and the consumption of sufentanil within 24 h after operation in group A and B were significantly lower than group C; VAS score 6 h after operation in group A was significantly lower than that in group B (P<0.05). The levels of WBC, neutrophil percentage, CRP, TNF-α, IL-1 and IL-6 in the 3 groups 24 h after surgery were significantly increased, compared with 30 min before surgery; the levels of above indexes in group A and B were significantly lower than those in group C (P<0.05). PSQI score and BDI score 0, 1 and 2 days after operation in group A and B were significantly lower than those in group C, while BDI score 0 day after operation in group A was significantly lower than that in group B (P<0.05). The total incidence of adverse reaction in group A, B and C were 5.0%, 10.0% and 17.5%, without statistical significance (P>0.05). CONCLUSIONS The low-dose esketamine has significant analgesic effect after thoracoscopic surgery, can reduce the levels of inflammatory factors after surgery and improve sleep quality and depression, with good safety.
期刊: 2023年第34卷第06期
作者: 高静静;钱向东;周海鸥
AUTHORS: GAO Jingjing,QIAN Xiangdong,ZHOU Haiou
关键字: 艾司氯胺酮;小剂量;胸腔镜手术;术后镇痛;炎症因子
KEYWORDS: esketamine; low-dose; thoracoscopic surgery;
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