不同亚麻醉剂量艾司氯胺酮对机器人辅助前列腺癌根治术老年患者肺损伤的影响
Effects of different subanesthetic doses of esketamine on lung injury in elderly patients undergoing robot-assisted radical prostatectomy
秦海倩 1卢悦淳 1吕欢欢 1陈会敏 1程莉1
作者信息
- 1. 天津医科大学第二医院麻醉科,天津 300211
- 折叠
摘要
目的 评价不同亚麻醉剂量艾司氯胺酮对机器人辅助前列腺癌根治术老年患者肺损伤的影响.方法 择期全身麻醉下行机器人辅助前列腺癌根治术患者90例,年龄65～80岁,ASA分级Ⅱ或Ⅱ级,BMI 19～27 kg/m2,加泰罗尼亚外科患者呼吸风险评估系统评分为高中危.采用随机数字表法分为3组(n=30):低剂量艾司氯胺酮组(ES1组)麻醉诱导时静脉注射艾司氯胺酮0.2 mg/kg,随后静脉输注艾司氯胺酮0.125 mg·kg-1·h-1至术毕前30 min;极低剂量艾司氯胺酮组(ES2组)麻醉诱导时静脉注射艾司氯胺酮0.1 mg/kg,随后静脉输注艾司氯胺酮0.015 mg·kg-1·h-1至术毕前30 min;对照组(C组)给予等量生理盐水.于诱导前(To)和术毕时采集桡动脉血样,采用ELISA法测定血清肺Clara细胞分泌蛋白(CC-16)和晚期糖基化终产物受体的可溶形式(sRAGE)浓度.于机械通气后5 min(T1)、气腹联合体位1 h(T2)、气腹联合体位2h(T3)和术毕前5 min(T4)时记录驱动压(DP)、肺动态顺应性(Cdyn)和机械功率(MP)等呼吸力学指标;于T0、T,、T3和麻醉复苏室(PACU)时采集桡动脉血样行血气分析记录肺泡-动脉血氧分压差(PA-aO2)和氧合指数(OI).记录术后24 h内不良反应及7 d内术后肺部并发症(PPCs)的发生情况.结果 与C组比较,ES1组与ES2组术毕时血清CC-16和sRAGE浓度降低,PACU时OI升高,PA-aO2降低,术后24 h内恶心反应降低(P＜0.05或0.01);与ES2组相比,ES1组术毕时血清CC-16和sRAGE浓度降低(P＜0.05).3组T1-4时DP、Cdyn、MP和术后7 d内PPCs发生率比较差异无统计学意义(P＞0.05).结论 亚麻醉剂量艾司氯胺酮0.2 mg/kg麻醉诱导,继以0.125 mg·kg-1·h-1静脉输注可减轻机器人辅助前列腺癌根治术老年患者肺损伤.
Abstract
Objective To evaluate the effects of different subanesthetic doses of esketamine on lung injury in elderly patients undergoing robot-assisted radical prostatectomy.Methods Ninety American Society of Anesthesiologists Physical Status classification Ⅱ or Ⅲ patients,aged 65-80 yr,with body mass index of 19-27 kg/m2,scheduled for elective robot-assisted radical prostatectomy under general anesthesia,identified as having middle and high risk using the Assess Respiratory Risk in Surgical Patients in Catalo-nia,were divided into 3 groups(n=30 each)using a random number table method:low-dose esketamine group(ES1 group),extremely low-dose esketamine group(ES2 group)and control group(C group).In ES1 group,esketamine was intravenously injected as a bolus of 0.2 mg/kg during anesthesia induction fol-lowed by an infusion of 0.125 mg·kg-1·h-1 until 30 min before the end of operation.In ES2 group,esket-amine was intravenously injected as a bolus of 0.1 mg/kg during anesthesia induction followed by an infusion of 0.015 mg·kg-1·h-1until 30 min before the end of operation.The equal volume of normal saline was given instead in C group.Radial artery blood samples were collected before anesthesia induction(To)and at the end of operation for determination of concentrations of Clara cell secretory protein(CC-16)and soluble form of advanced glycation end products receptor(sRAGE)in serum by enzyme-linked immunosorbent as-say.The parameters of respiratory mechanics such as the driving pressure,dynamic lung compliance and mechanical power were recorded at 5 min after mechanical ventilation(T1),and at 1 and 2 h after Tren-delenburg position combined with pneumoperitoneum(T2.3),and at 5 min before the end of operation(T4).Blood samples were collected from the radial artery at To,T1,T3 and in the postanesthesia care unit for blood gas analysis,and the alveolar-arterial partial oxygen pressure difference and oxygenation index were recorded.The adverse reactions within 24 h after operation and the occurrence of postoperative pulmonary complications within 7 days after operation were recorded.Results Compared with C group,the serum CC-16 and sRAGE concentrations were significantly decreased at the end of operation,the oxygenation index was increased and the alveolar-arterial partial oxygen pressure difference was decreased in the postanesthesia care unit,and the incidence of postoperative nausea reactions within 24 h after operation was decreased in ES1 and ES2 groups(P＜0.05 or 0.01).Compared with ES2 group,the serum CC-16 and sRAGE concen-trations were significantly decreased at the end of operation in ES1 group(P＜0.05).There were no statisti-cally significant differences in the driving pressure,dynamic lung compliance and mechanical power at T1-4 and the incidence of postoperative pulmonary complications within 7 days after surgery among the three groups(P＞0.05).Conclusions Esketamine given as a subanesthetic bolus of 0.2 mg/kg during anesthesia induction followed by an infusion of 0.125 mg·kg-1·h-1 can alleviate lung injury in elderly patients under-going robot-assisted radical prostatectomy.
关键词
环己烷类/前列腺肿瘤/机器人手术/老年人/肺损伤Key words
Cyclohexanes/Prostatic neoplasms/Robotic surgical procedures/Aged/Lung injury引用本文复制引用
基金项目
天津麻醉科研发展计划项目(TJMZ2022-03)
出版年
2024
NETL
NSTL
万方数据