摘要
目的 探讨静脉滴注艾司氯胺酮联合超声引导下前锯肌平面阻滞在肺结节患者胸腔镜下肺楔形切除术中的应用效果.方法 前瞻性选取2023年1月至11月安徽省胸科医院收治的90例肺结节患者,按照随机数字表法将其分为观察组与对照组,各45例.两组均实施胸腔镜下肺楔形切除术,观察组患者全身麻醉诱导后,采取超声引导下前锯肌平面阻滞,诱导前注射0.1 mg/kg的艾司氯胺酮,术中泵注艾司氯胺酮.对照组患者采取相同的全身麻醉诱导与超声引导下前锯肌平面阻滞.比较两组患者入室时(T1)、手术10 min(T2)、手术30 min(T3)、手术结束即刻(T4)的基础指标[心率、血氧饱和度(SpO2)、收缩压及舒张压]变化,对比拔管后0.5、2、24、48、72 h的咳嗽时和静息时疼痛程度,比较术前和术后24 h相关血液指标[丙氨酸转移酶(ALT)、天冬氨酸转移酶(AST)、血肌酐、白细胞(WBC)计数、C反应蛋白(CRP)]表达水平,比较静脉PCIA泵按压次数、不良反应发生率及镇痛满意度,最后采用焦虑自评量表(SAS)及抑郁自评量表(SDS)对患者心理状态进行评估.结果 两组患者T1、T4时的心率、SpO2、舒张压、收缩压比较,差异均无统计学意义(P＞0.05);观察组患者T2及T3时心率、SpO2、舒张压、收缩压水平均低于对照组,差异均有统计学意义(P＜0.05).观察组拔管后 2、24、48、72 h 咳嗽时 VAS 评分分别为(5.78±0.35)、(4.23±0.36)、(3.74±0.52)、(3.11±0.26)分,静息时(4.41±1.23)、(4.04±0.21)、(3.01±0.31)、(2.13±0.32)分,均低于对照组,差异均有统计学意义(P＜0.05).术后24h,两组患者ALT、AST、血肌酐组间比较,差异均无统计学意义(P＞0.05),而观察组WBC、CRP水平分别为(15.36±2.52)×109/L、(26.12±2.64)μg/mL,均低于对照组,差异均有统计学意义(P＜0.05).观察组静脉PCIA泵按压为(3.43±1.02)次,不良反应发生率为4.44％,均明显低于对照组,镇痛效果满意度为97.78％,高于对照组,差异均有统计学意义(P＜0.05).术后48 h,观察组患者SAS、SDS评分分别为(25.02±5.73)、(21.54±4.21)分,均低于对照组,差异均有统计学意义(P＜0.05).结论 静脉滴注艾司氯胺酮联合超声引导下前锯肌平面阻滞可稳定肺结节患者胸腔镜下肺楔形切除术患者生命体征,减轻术后静息时和咳嗽时疼痛程度,减轻术后由疼痛应激反应造成的炎症反应,减低术后静脉脉PCIA泵按压次数与不良反应发生率,且镇痛效果满意度较高,能够进一步改善患者围手术期焦虑、抑郁情绪.
Abstract
Objective To explore the application effect of intravenous infusion of ketamine combined with ultrasound-guided plane block of the serratus anterior muscle in thoracoscopic wedge resection of lung nodules in patients.Methods This study was a prospective analysis of 90 patients with pulmonary nodules admitted to Anhui Chest Hospital from January 2023 to November 2023,which were divided into the observation group and the control group according to the random number table method,each with 45 cases.All patients underwent thoracoscopic lung wedge resection,and the patients in the observation group were induced with general anesthesia with ultrasound-guided anterior serratus muscle plane block,injected with 0.1 mg/kg of esketamine before induction,and pumped with esketamine during the operation.Patients in the control group took the same induction of general anesthesia with ultrasound-guided anterior serratus plane block.The changes of basic indexes such as heart rate,oxygen saturation(SpO2),systolic blood pressure and diastolic blood pressure at the time of admission to the room(T1),10 min of the sur-gery(T2),30 min of the surgery(T3),and the moment of the end of the surgery(T4)of the patients in the two groups were compared,and the degree of pain at 0.5,2,24,48,and 72 h after extubation of the couch and the time of the rest,and to compare the changes in expression levels of relevant blood indices[alanine aminotransferase(ALT),alanine transaminase(AST),blood creatinine,white blood cell(WBC)count,C-reactive protein(CRP)]before and 24 h after surgery were compared,the number of presses with the intravenous PCIA pump,the incidence of adverse reactions and the satisfaction of analgesia,and finally,the psychological status of the patients were evaluated by using the self-rating anx-iety scale(SAS)and self-ratingdepression scale(SDS).Results There were no statistically significant differences in heart rate,SpO2,dias-tolic blood pressure,and systolic blood pressure between the two groups of patients at T1 and T4(P＞0.05);the heart rate,SpO2,diastolic blood pressure,and systolic blood pressure of the observation group patients at T2 and T3 were lower than those of the control group on average,and the differences were statistically significant(P＜0.05).The VAS scores of the observation group at 2,24,48,and 72 h after extubation were(5.78±0.35),(4.23±0.36),(3.74±0.52),and(3.11±0.26)points,respectively,and at rest were(4.41±1.23),(4.04±0.21),(3.01±0.31),and(2.13±0.32)points,respectively,which were lower than those of the control group,and the differences were statistically significant(P＜0.05).At 24 h after surgery,there was no statistically significant difference in ALT,AST,and blood creatinine levels between the two groups of patients(P＞0.05),while the WBC and CRP levels in the observation group were(15.36±2.52)×109/L and(26.12±2.64)μg/mL,respectively,which were lower than those in the control group,and the differences were statistically significant(P＜0.05).The number of times the PCIA pump was pressed in the observation group was(3.43±1.02),the incidence of adverse reactions was 4.44％,which were lower than thoseof the control group,and the satisfaction rate of analgesic effect was 97.78％,which was higher than that of the control group,and the differences were statistically significant(P＜0.05).At 48 hours after surgery,the SAS and SDS scores of the observation group were(25.02±5.73)and(21.54±4.21)points,respectively,which were lower than those of the control group,and the differences were statis-tically significant(P＜0.05).Conclusion Intravenous infusion of ketamine combined with ultrasound-guided plane block of the serratus ante-rior muscle can stabilize the vital signs of patients undergoing thoracoscopic wedge resection of lung nodules,reduce pain levels during rest and coughing,alleviate inflammatory reactions caused by pain stress reactions after surgery,reduce the number of PCIA pump compressions and inci-dence of adverse reactions after surgery,and have high satisfaction with the analgesic effect,It can further improve the patient's perioperative anxie-ty and depression.
基金项目
安徽省卫生健康委员会科研项目(AHWJ2021a024)
NETL
NSTL
万方数据