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投稿时间：2023-11-08 网络发布日期：2024-08-20
投稿时间：2023-11-08 网络发布日期：2024-08-20
中文摘要: 目的 探究静脉推注和静脉泵注艾司氯胺酮对胸腔镜肺手术患者术后疼痛的影响。方法 选择青岛市市立医院2023年1月至6月择期行胸腔镜肺手术的患者90例，采用随机数字表法分为三组，艾司氯胺酮1组（EK1组，气管插管后予以艾司氯胺酮0.25 mg/kg静脉推注）；艾司氯胺酮2组（EK2组，气管插管后以0.125 mg·kg-1·h-1的速度静脉泵注艾司氯胺酮2 h）；对照组（C组，不给予艾司氯胺酮），各30例。三组均采用静脉快速诱导，双腔气管插管后，超声引导下行手术切口肋间神经阻滞。术后疼痛数字分级评分法（NRS）评分≥4分时，给予地佐辛静脉注射补救镇痛，单次剂量5 mg。记录患者术后不同时间点的NRS评分、血流动力学指标、血气指标。比较三组补救镇痛情况及不良反应。结果 三组间NRS评分差异有统计学意义（P＜0.05），艾司氯胺酮组（EK1组、EK2组）在各时间点的NRS评分低于C组（P＜0.05）。EK1组、EK2组、C组术后48 h内补救镇痛例数分别为2、3、13例。艾司氯胺酮组（EK1组、EK2组）的补救镇痛率、地佐辛用量均低于C组（P＜0.05），首次按压镇痛泵时间晚于C组（P＜0.05）。三组术后不良反应发生率比较差异无统计学意义（P＞0.05）。结论 胸腔镜肺手术患者术中应用亚麻醉剂量艾司氯胺酮，单次静脉推注和持续静脉泵注均可达到减轻患者术后急性疼痛的目的，不增加术后不良反应。术前单次静脉注射较持续静脉泵注操作简便，且无苏醒延迟的顾虑，更推荐用于胸腔镜肺手术的镇痛。
Abstract:Objective To investigate the effect of itravenous injection or infuson of esketamine on postoperative pain in patients undergoing thoracoscopic lung surgery. Methods A total of 90 patients who underwent elective thoracoscopic lung surgery in Qingdao Municipal Hospital from January to June 2023 were selected and randomly divided into three groups: esketamine group 1 (EK1 group, 0.25 mg/kg of esketamine was injected intravenously after endotracheal intubation), esketamine group 2 (EK2 group, intravenous infusion of esketamine at a rate of 0.125 mg·kg-1·h-1 for 2 hours after endotracheal intubation), and control group (C group, no administration of esketamine). All three groups were treated with intravenous rapid induction, double lumen tracheal intubation, and ultrasound guided surgical incision intercostal nerve block. When the postoperative pain numerical rating scale (NRS) score≥4 points, dezocine was given intravenously for rescue analgesia, with a single dose of 5 mg. The NRS score, hemodynamic indexes and blood gas indexes at different time points after operation were recorded. The rescue analgesia and adverse reactions of the three groups were compared. Results There was significant difference in NRS scores among the three groups (P＜0.05), and NRS scores of esketamine group (EK1 group and EK2 group) at each time point were lower than those of C group (P＜0.05). The number of cases of rescue analgesia within 48 h after operation in EK1 group, EK2 group and C group were 2, 3 and 13 cases respectively. The rescue analgesic rate and dezocine dosage of esketamine group (EK1 group and EK2 group) were lower than those of C group (P＜0.05), and the time of first pressing analgesic pump was later than that of C group (P＜0.05). There was no significant difference in the incidence of postoperative adverse reactions among the three groups (P＞0.05). Conclusion Intraoperative use of subanesthetic dose of esketamine, single intravenous injection, and continuous intravenous infusion can achieve the goal of reducing postoperative acute pain in patients undergoing thoracoscopic lung surgery, without increasing postoperative adverse reactions. Pre-operative single intravenous injection is more convenient to operate than continuous intravenous infusion, and there is no concern of delayed recovery. It is more recommended for pain relief in thoracoscopic lung surgery.
keywords: Esketamine Thoracoscopy Postoperative pain Blood pressure Dezocine Intravenous injection Intravenous infusion Subanaesthetic dose
文章编号： 中图分类号：R614 文献标志码：A
基金项目:青岛市医药卫生科研计划项目（2021-WJZD029）
| Author Name | Affiliation |
| LI Liangyu, XIN Yan, PENG Xiaoyan, CAO Xi, AI Dengbin | *Shandong Second Medical University, Weifang, Shandong 261053, China |
引用文本：
李靓宇,辛艳,彭霄艳,等.艾司氯胺酮不同给药方式对胸腔镜肺手术术后疼痛的影响[J].中国临床研究,2024,37(8):1192-1196.
李靓宇,辛艳,彭霄艳,等.艾司氯胺酮不同给药方式对胸腔镜肺手术术后疼痛的影响[J].中国临床研究,2024,37(8):1192-1196.