2025 年第 4 期 第 20 卷

艾司氯胺酮应用于胸腔镜肺切除手术双腔气管插管全身麻醉中的镇痛效果

The analgesic effect of esmketamine in general anesthesia with double-lumen endotracheal intubation for thoracoscopic pneumonectomy

作者：张欢欢孔婧孟璐姚晶曼胡友洋马冬春

英文作者：Zhang Huanhuan Kong Jing Meng Lu Yao Jingman Hu Youyang Ma Dongchun

单位：安徽省胸科医院（安徽省结核病防治研究所）麻醉科，合肥230032

英文单位：Department of Anesthesiology Anhui Chest Hospital Anhui Tuberculosis Research Institute Hefei 230032 China

关键词：胸腔镜肺切除手术；艾司氯胺酮；双腔气管插管；血流动力学；镇痛

英文关键词：Thoracoscopicpneumonectomy;Esketamine;Double-lumenendotrachealintubation;Hemodynamics;Analgesia

• 摘要：

• 目的 观察艾司氯胺酮应用于胸腔镜肺切除手术双腔气管插管全身麻醉中的镇痛效果。方法 选取2022年7月1日至2023年6月30日在安徽省胸科医院进行胸腔镜肺切除手术的118例患者为研究对象，采用简单随机法分为对照组和观察组，各59例。对照组麻醉诱导后给予丙泊酚和瑞芬太尼麻醉维持，观察组麻醉诱导后在对照组基础上加入艾司氯胺酮进行复合麻醉维持。比较2组术中血流动力学指标变化情况、围手术期阿片类药物用量及术后镇痛情况和不良反应发生情况。结果 2组麻醉诱导前（T0）平均动脉压（MAP）、心率比较差异均无统计学意义（均P＞0.05）。2组插管后即刻（T1）和双腔管进胸腔后5 min（T2）时MAP、心率均低于T0时，差异均有统计学意义（均P＜0.05），拔双腔管后10 min（T3）时与同组T0时比较差异均无统计学意义（均P＞0.05）。观察组T1时MAP、心率高于对照组同时点，但T2、T3时MAP、心率与对照组同时点比较差异均无统计学意义（均P＞0.05）。观察组围术期瑞芬太尼和舒芬太尼使用剂量均低于对照组，差异均有统计学意义（均P＜0.001）。观察组术后首次按压镇痛泵时间晚于对照组［（80±12）min比（46±8）min］，24 h实际和有效按压次数、酮咯酸氨丁三醇使用剂量均少于对照组［（5.8±3.2）次比（10.3±4.1）次、（5.9±3.0）次比（10.3±4.3）次、（304±20）mg比（712±29）mg］（均P＜0.05），但2组视觉模拟量表评分＞4分发生率比较差异无统计学意义（P＞0.05）。2组术后24 h时前列腺素E2、皮质醇、去甲肾上腺素均高于同组术前，但观察组均低于对照组，差异均有统计学意义（均P＜0.05）。观察组恶心呕吐发生率低于对照组，差异有统计学意义（P=0.038），但头晕、呼吸抑制、瘙痒、躁动、幻觉的发生率与对照组比较，差异均无统计学意义（均P＞0.05）。结论 艾司氯胺酮应用于胸腔镜肺切除手术双腔气管插管全身麻醉中可稳定血流动力学，减少阿片类药物用量，镇痛效果较好。

• Objective To observe the analgesic effect of esmketamine in general anesthesia with double-lumen endotracheal intubation for thoracoscopic pneumonectomy. Methods A total of 118 patients who underwent thoracoscopic pneumonectomy in Anhui Chest Hospital from July 1, 2022 to June 30, 2023 were selected as the research objects. They were divided into the control group and the observation group by simple random method, with 59 cases in each group. The control group was given propofol and remifentanil for anesthesia maintenance after anesthesia induction, and the observation group was added esketamine for combined anesthesia maintenance on the basis of the control group after anesthesia induction. The intraoperative hemodynamics, perioperative opioid consumption, postoperative analgesia and adverse reactions were compared between the two groups.Results There was no significant difference in mean arterial pressure (MAP) and heart rate between the two groups before anesthesia induction (T0)(both P＞0.05). The MAP and heart rate immediately after intubation(T1) and at 5 min after double-lumen tube insertion(T2) were lower than those at T0 in both groups(all P＜0.05). There was no significant difference between 10 min after removal of double-lumen tube (T3) and T0 in the same group (all P＞0.05). The MAP and heart rate of the observation group at T1 were higher than those of the control group at the same time point, but there were no statistically significant differences in MAP and heart rate between the two groups at T2 and T3 (all P > 0.05). The perioperative doses of remifentanil and sufentanil in the observation group were lower than those in the control group (both P＜0.001). The time of first pressing analgesic pump after surgery in the observation group was later than that in the control group［(80±12)min vs (46±8)min］, the actual and effective pressing times within 24 hours and the dosage of ketochromate tromethamine were less than those in the control group［(5.8±3.2)times vs (10.3±4.1)times, (5.9±3.0)times vs (10.3±4.3)times, (304±20)mg vs (712±29)mg］(all P＜0.05). However, there was no significant difference in the incidence of visual analogue scale score> 4 between the two groups (P＞0.05). The levels of prostaglandin E2, cortisol and norepinephrine in the two groups at 24 hours after operation were higher than those before operation, but those in the observation group were lower than those in the control group (all P＜0.05). The incidence of nausea and vomiting in the observation group was lower than that in the control group, and the difference was statistically significant (P=0.038). However, there was no significant difference in the incidence of dizziness, respiratory depression, pruritus, restlessness and hallucination between the two groups (all P＞0.05). Conclusion The application of esmketamine in general anesthesia with double-lumen endotracheal intubation in thoracoscopic pneumonectomy can stabilize hemodynamics, reduce the dosage of opioids, and have good analgesic effect.