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Received:June 12, 2024 Published Online:December 21, 2024
Received:June 12, 2024 Published Online:December 21, 2024
中文摘要: 目的 观察胸腔镜肺叶切除术中持续静脉输注艾司氯胺酮并联合胸椎旁神经阻滞（TPVB），对患者术后早期睡眠、镇痛及恢复质量的影响。方法 选择2023年1月至2024年1月于南京市第一医院择期行胸腔镜下肺叶切除术的患者76例，随机分成对照组（C组）和艾司氯胺酮组（E组），每组各38例。E组患者在麻醉诱导时静脉注射0.2 mg/kg 艾司氯胺酮，随后持续泵注0.1 mg·kg-1·h-1艾司氯胺酮，直至手术结束。C组患者给予等量生理盐水。于术前1 d、术后 1 d和术后3 d，采用多导睡眠监测仪监测患者睡眠情况并采用匹兹堡睡眠质量指数（PSQI）量表评估睡眠质量。记录术后2、6、12、24、48 h的视觉模拟评分（VAS）和术后48 h 患者静脉自控镇痛（PCIA）按压次数以及补救镇痛率。于术前1 d、术后 1 d和术后3 d采用医院焦虑抑郁量表(HADS)记录焦虑(HADS-A)和抑郁(HADS-D)评分。于术后1、3 d行15项恢复质量评分（QoR-15）评分,并记录患者排气时间。结果 E组患者术后第1、3天的总睡眠时间长于C组、睡眠效率指数和快速动眼睡眠占比高于C组（P＜0.05）；另外，术后1、3 d的PSQI得分，E组患者明显低于C组（P＜0.05）。两组患者术后4 h、12 h的VAS评分以及术后48 h补救镇痛率差异无统计学意义（P＞0.05）；然而E组患者术后24 h、48 h的VAS评分明显低于C组（P＜0.05），并且术后48 h PCIA按压次数明显少于C组［（13.8±4.3）次 vs （16.2±3.7）次，t=2.556， P=0.013］。与C组相比，E组患者术后1、3d的HADS-A和HADS-D评分较低、QoR-15评分较高（P＜0.05），且排气时间明显提早［（17.1±2.0）h vs （18.3±2.1）h， t=2.646， P=0.010］。结论 术中静脉输注艾司氯胺酮联合TPVB可以一定程度改善胸腔镜肺叶切除术患者术后早期睡眠、焦虑抑郁并促进术后恢复。
Abstract:Objective To observe the effects of continuous intravenous infusion of esketamine combined with thoracic paravertebral nerve block (TPVB) on postoperative early sleep, analgesia, and recovery quality in patients undergoing thoracoscopic lobectomy. Methods A total of 76 patients scheduled for elective thoracoscopic lobectomy at Nanjing First Hospital from January 2023 to January 2024 were randomly divided into two groups: the control group (C group) and the esketamine group (E group), with 38 patients in each group. Patients in the E group received intravenous injection of 0.2 mg/kg esketamine during anesthesia induction, followed by a continuous infusion of 0.1 mg·kg-1·h-1 esketamine until the end of the surgery. Patients in the C group received an equal volume of normal saline. Multichannel〖LM〗 sleep monitoring was conducted on the day before surgery, the first day after surgery, and the third day after surgery to assess patients sleep conditions. The Pittsburgh Sleep Quality Index (PSQI) was used to evaluate sleep quality on the same days. Visual Analog Scale (VAS) scores were recorded at 2, 6, 12, 24, and 48 hours postoperatively, along with patient-controlled intravenous analgesia (PCIA) pressing times and rescue analgesia rates within 48 hours after surgery. The Hospital Anxiety and Depression Scale (HADS) was used to assess anxiety (HADS-A) and depression (HADS-D) scores on one day before surgery, the first and third days after surgery. Recovery quality was assessed using the Quality of Recovery-15 (QoR-15) on the first and third days after surgery, and the time of flatus was recorded. Results Compared with the C group, the total sleep time, sleep efficiency index, proportion of rapid eye movement were higher, while PSQI score was lower in the E group on the first and third postoperative days (P<0.05). VAS scores at 24 hours and 48 hours after surgery were significantly lower in the E group than those in the C group (P＜0.05), and the PCIA pressing times at 48 hours postoperatively were significantly lower than those in the E group [(13.8±4.3) times vs (16.2±3.7) times, t=2.556, P=0.013]. Compared with the C group, the HADS-A and HADS-D scores were lower, the QoR-15 scores were higher (P＜0.05) on the first and third days after surgery, and the flatus time occurring significantly earlier [(17.1±2.0) h vs (18.3±2.1) h, t=2.646, P=0.010] in the E group. Conclusion Intraoperative intravenous infusion of esketamine combined with TPVB can improve early postoperative sleep, anxiety, and depression, and promote recovery in patients undergoing thoracoscopic lobectomy to a certain extent.
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