首页|艾司氯胺酮对胸腔镜下肺结节切除术患者围术期疼痛及抑郁的影响

艾司氯胺酮对胸腔镜下肺结节切除术患者围术期疼痛及抑郁的影响

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目的 探讨艾司氯胺酮对胸腔镜下肺结节切除术患者围术期疼痛和抑郁的影响。方法 将120例择期行胸腔镜下肺结节切除术患者随机分为低剂量艾司氯胺酮组(L组)、高剂量艾司氯胺酮组(H组)和生理盐水对照组(C组),每组40例。在麻醉诱导后的切皮前分别给予3组患者艾司氯胺酮0。25 mg/kg、艾司氯胺酮0。50 mg/kg和等量生理盐水。比较3组患者术前1 d(T0)、术后第1天(T1)、术后第3天(T2)和出院当天(T3)的疼痛视觉模拟评分法(VAS)、抑郁自评量表(SDS)评分,记录术后24 h的镇痛情况以及围术期不良反应的发生情况。结果 L组和H组T1时静息和咳嗽下的VAS评分低于C组,差异有统计学意义(P<0。05);与C组相比,L组和H组24 h内镇痛泵的总按压次数以及有效按压次数均减少,舒芬太尼用量也降低,差异有统计学意义(P<0。05)。3组患者不同时点抑郁评分比较,差异均无统计学意义(P>0。05)。3组恶心、呕吐、头晕、幻觉、噩梦的发生率比较,差异无统计学意义(P>0。05)。结论 艾司氯胺酮能有效减轻胸腔镜下肺结节切除术患者术后第1天的疼痛程度,减少术后阿片类镇痛药物用量,且不增加不良反应的发生;与0。25 mg/kg艾司氯胺酮相比,0。50 mg/kg艾司氯胺酮未能显示更好的术后镇痛效果和围术期抑郁改善效果。
Effect of esketamine on perioperative pain and depression in patients with thoracoscopic pulmonary nodule resection
Objective To investigate the effect of esketamine on perioperative pain and depression in patients with thoracoscopic pulmonary nodule resection.Methods A total of 120 patients with selec-tive thoracoscopic pulmonary nodule resection were randomly divided into low-dose esketamine group(group L),high-dose esketamine group(group H)and saline control group(group C),with 40 cases in each group.Before skin incisionafter anesthetic induction,0.25 mg/kgesketamine,0.50 mg/kg esketamine and the equivalent amount of saline were separately administered for patients in the three groups.Visual Analogue Scale(VAS)score for pain and the Self-rating Depression Scale(SDS)score were compared among the three groups at the time points of one day before surgery(T0),one day after surgery(T1),three days after surgery(T2),and the day of discharge(T3),and postopera-tive analgesia within 24 h and perioperative adverse reactions were also recorded.Results The VAS scores for rest and coughing at T1 were significantly lower in group L and group H than group C(P<0.05);compared with group C,the total press number of analgesic pump with in 24 h and effec-tive press number were significantly decreased in group L and group H,and the dosage of sufentanil was also significantly decreased(P<0.05).There were no significant differences in depression scores at different time points among the three groups(P>0.05).There were no significant differences in the incidence rates of nausea,vomiting,dizziness,hallucinations,and nightmares among the three groups(P>0.05).Conclusion Esketamine can effectively alleviate pain on the first day after oper-ation and reduce the dosage of opioid analgesics without increasing the incidence of adverse reactions in patients with thoracoscopic pulmonary nodule resection;compared with 0.25 mg/kg esketamine,0.50 mg/kg esketamine doesn't demonstrate better postoperative analgesia or improvement in periop-erative depression.

esketaminepulmonary nodulethoracoscopic pulmonary nodule resectionpaindepressionadverse reactions

陆燕丰、戴家宝、吴周全、邹志清

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南京医科大学附属常州第二人民医院麻醉科,江苏常州,213000

艾司氯胺酮 肺结节 胸腔镜肺结节切除术 疼痛 抑郁 不良反应

江苏省高层次卫生人才"六个一工程"拔尖人才科研项目

LGY2020037

2024

实用临床医药杂志
扬州大学,中国高校科技期刊研究会

实用临床医药杂志

CSTPCD
影响因子:1.543
ISSN:1672-2353
年,卷(期):2024.28(9)
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