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投稿时间：2024-06-05 网络发布日期：2024-12-21
投稿时间：2024-06-05 网络发布日期：2024-12-21
中文摘要: 目的 比较无阿片药物麻醉（OFA）和阿片药物麻醉（OA）对胸腔镜手术患者血流动力学和应激反应的影响。方法 选择阜阳市人民医院2023年1月至10月拟全麻下行胸腔镜肺大疱或肺叶切除手术的患者110例，随机分为阿片类药物麻醉组（OA组，n=55）和无阿片类药物麻醉组（OFA组，n=55），OA组术中使用常规阿片类药物全麻联合胸椎旁间隙阻滞进行麻醉，OFA组使用艾司氯胺酮全麻联合胸椎旁间隙阻滞进行麻醉，观察患者术中不同时间点的血流动力学指标 [平均动脉压（MAP）、心率（HR）］，应激反应指标 [血糖、血浆皮质醇（Cor）、血浆8-异前列腺素F2α（8-iso）］和术中丙泊酚用量，术后复苏时间、视觉模拟疼痛评分（VAS）和不良反应（恶心呕吐、皮肤瘙痒、精神症状）发生情况。结果 研究初始纳入患者110例，其中4例被剔除（1例中转开胸手术，1例术中发生过敏反应，2例失访），最终OA组和OFA组各53例。OFA组在诱导、插管、切皮时MAP和HR均高于OA组（P＜0.05），在拔管时，MAP及HR均低于OA组（P＜0.05），术中丙泊酚用量低于OA组 [（428.4±147.5）mg vs （499.5±171.1）mg, t=2.291, P＝0.024］，术后恶心呕吐发生率低于OA组(1.89% vs 15.09%, χ2=4.371, P=0.037)；两组患者术中各时点血糖、Cor、8-iso，术后复苏时间、皮肤瘙痒与精神症状发生率及VAS疼痛评分对比，差异无统计学意义（P＞0.05）。结论 艾司氯胺酮全麻联合胸椎旁间隙阻滞的多模式OFA方案用于胸腔镜手术麻醉可以有效控制手术应激反应，减少术中丙泊酚用量，有利于维持患者麻醉期间循环稳定。
Abstract:Objective To compare the hemodynamics and stress reaction of opioid free anesthesia (OFA) and opioid anesthesia (OA) in patients undergoing video-assisted thoracoscopic surgery. Methods A total of 110 patients who underwent thoracoscopic bullectomy or lobectomy under general anesthesia at Fuyang People’s Hospital from January to October 2023 were randomly divided into OA group (n=55) and OFA group (n=55). Patients in OA group received OA combined with thoracic paravertebral nerve block during surgery, while the patients in OFA group used esketamine instead of opioids. Hemodynamic indicators [mean arterial pressure (MAP) and heart rate (HR)] and stress response indicators [blood glucose (Glu), cortisol (Cor), 8-isoprostaglandin F2α (8-iso)] at different time points and the dosage of propofol used during surgery were observed. Postoperative recovery time, Visual Analogue Scale (VAS) score and adverse reactions (nausea, vomiting, skin itching and mental symptoms) within 48 h after surgery were recorded. Results At the beginning of the study, 110 patients were included, of which 4 patients were excluded (1 patient was converted to open chest surgery, 1 patient experienced allergic reactions during surgery, and 2 patients were lost to follow-up). Finally, 53 cases were included in each of OA group and OFA group. Compared with the OA group, MAP and HR were significantly higher during induction, intubation and skin incision, while MAP and HR were significantly lower during extubation in OFA group (P＜0.05). And the dosage of propofol used during surgery was lower in the OFA group than that in the OA group [(428.4±147.5)mg vs (499.5±171.1) mg, t=2.291, P=0.024]. Besides, the incidence of postoperative nausea and vomiting was lower in the OFA group (1.89% vs 15.09%, χ2=4.371, P=0.037). There was no statistically significant difference in the stress response indicators (Glu, Cor, 8-iso), postoperative recovery time, incidence of skin itching and mental symptoms, and VAS score between two groups (P＞0.05). Conclusion Multimodal OFA using esketamine combined with thoracic paravertebral nerve block can effectively control surgical stress response, reduce intraoperative propofol dosage, maintain the circulatory system steady during anesthesia.
keywords: Opioid free anesthesia Esketamine Stress response Thoracic paravertebral nerve block Thoracoscopic surgery Propofol
文章编号： 中图分类号：R614.2 文献标志码：A
基金项目:安徽省卫健委科研项目（AHWJ2023BAc20120）；阜阳市卫健委科研项目（FY2021-013）
附件
| Author Name | Affiliation |
| WU Meichao, YANG Fangfang, CAI Ning, MA Xingjun | Department of Anesthesia, Fuyang People’s Hospital Affiliated to Anhui Medical University, Fuyang, Anhui 236000, China |
引用文本：
吴美潮，杨芳芳，蔡宁，马行军.多模式无阿片药物麻醉对胸腔镜手术患者应激反应及血流动力学的影响[J].中国临床研究,2024,37(12):1839-1844.
吴美潮，杨芳芳，蔡宁，马行军.多模式无阿片药物麻醉对胸腔镜手术患者应激反应及血流动力学的影响[J].中国临床研究,2024,37(12):1839-1844.