| 李发展,邓志敏,高泉,等.小剂量艾司氯胺酮联合胸椎旁神经阻滞对老年病人胸腔镜肺癌手术应激反应和术后恢复的影响[J].安徽医药,2026,30(2):409-414. |
| 小剂量艾司氯胺酮联合胸椎旁神经阻滞对老年病人胸腔镜肺癌手术应激反应和术后恢复的影响 |
| Clinical study on the effects of low-dose ketamine combined with thoracic paravertebral nerve block on stress response and postoperative recovery in elderly patients undergoing thoracoscopic lung cancer surgery |
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| DOI：10.3969/j.issn.1009-6469.2026.02.037 |
| 中文关键词: 肺肿瘤 艾司氯胺酮 胸椎旁神经阻滞 老年病人 胸腔镜手术 应激反应 |
| 英文关键词: Lung neoplasms Ketamine Parathoracic paravertebral nerve block Elderly patients Thoracoscopic surgery Stress response |
| 基金项目:佛山市自筹经费类科技创新项目( 2320001006190) |
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| 中文摘要: |
| 目的旨在评估胸椎旁神经阻滞( TPVB)联合艾司氯胺酮对老年病人胸腔镜肺癌手术应激反应和术后恢复影响。方法纳入 2024年 2―8月广东省中西医结合医院接受择期胸腔镜肺癌根治术的老年肺癌病人 66例，采用随机数字表法分为观察组和对照组，各 33例。对照组予以全身麻醉，观察组在麻醉诱导前予静脉注射艾司氯胺酮，双腔支气管插管成功后超声引导下行 TPVB。其余麻醉方法与对照组一致。观察两组病人麻醉诱导时( T0)、切皮时( T1)、手术后 30 min(T2)、手术结束时(T3)、术后 6h(T4)5个时间点的心率、平均动脉压( MBP)、血氧饱和度( SPO2)、白细胞介素 -6(IL-6)、血儿茶酚胺浓度和皮质醇(COR)的浓度。术后记录两组术后意识恢复指标、术后疼痛评分( VAS)、术后呼吸系统并发症、术后苏醒延迟、术后恶心呕吐(PONV)、入 ICU的例数。结果与对照组比较，在 T1［( 79.64±8.45)次 /分比( 85.37±12.28)次 /分］、 T4［( 77.52±8.76)次 /分比(82.56±10.24)次 /分］时间点观察组心率波动明显较小，差异有统计学意义( P<0.05)。与对照组比较，在 T0［( 76.38±6.95) mmHg比( 68.52±8.24)mmHg(1 mmHg=0.133 kPa)］、 T1［( 79.15±9.82)mmHg比( 85.73±12.67)mmHg］、 T4［( 78.09±8.96)mmHg比(84.12±11.83)mmHg］时间点观察组平均动脉压波动明显较小，差异有统计学意义( P<0.05)。两组麻醉期间血氧饱和度比较差异无统计学意义( P>0.05)。观察组在 T1、T2、T3时间段肾上腺素及去甲肾上腺素浓度值低于对照组，差异有统计学意义(P< 0.05)。观察组神经认知障碍发生率呈现降低趋势( 9.09%比 21.21%，OR=0.37，P=0.178)虽差异无统计学意义，但具有临床意义( NNT=9)。观察组在 T1、T2、T3、T4时间段 IL-6、皮质醇水平较对照组低，差异有统计学，意义( P<0.05)。观察组病人在术后意识障碍、 VAS评分较低，呼吸系统并发症发生率方面较低，虽差异无统计学意义( P>0.05)但绝对风险降低值得临床关注。而两组在术后苏醒延迟、入 ICU例数方面比较，差异无统计学意义( P>0.05)。结论 TPVB联合，艾司氯胺酮可减轻老年病人手 |
| 英文摘要: |
| Objective To evaluate the effects of thoracic paravertebral block (TPVB) combined with ketamine on stress response andpostoperative recovery in elderly patients undergoing thoracoscopic lung cancer surgery.Methods A total of 66 elderly patients whounderwent elective thoracoscopic radical resection for lung cancer in Guangdong Integrated Traditional Chinese and Western MedicineHospital between February to August 2024 were included. The control group received general anesthesia, while the experimental group received intravenous injection of ketamine before anesthesia induction. After successful double lumen bronchial intubation, TPVB wasperformed under ultrasound guidance. The remaining anesthesia methods were consistent with the control group. The heart rate, meanarterial pressure (MBP), SPO2, interleukin-6 (IL-6), blood catecholamine concentration, and cortisol (COR) concentration at five timepoints were observed: anesthesia induction (T0), skin incision (T1), 30 minutes after surgery (T2), end of surgery (T3), and 6 hours aftersurgery (T4) in two groups of patients. Postoperative consciousness recovery indicators, postoperative pain scores (VAS), postoperativerespiratory complications, postoperative delayed recovery, postoperative nausea and vomiting (PONV), and the number of patients ad-mitted to the ICU were recorded for both groups of patients. Results At time points T1 [(79.64±8.45) beats/min vs. (85.37±12.28) beats/min] and T4 [(77.52±8.76) beats/min vs. (82.56±10.24) beats/min], the heart rate fluctuations in the experimental group were sig-nificantly smaller, and the difference between the two groups was statistically significant (P<0.05). At T0 [(76.38±6.95) mmHg vs. (68.52±8.24) mmHg(1 mmHg=0.133 kPa)], T1 [(79.15±9.82) mmHg vs. (85.73±12.67) mmHg], and T4 [(78.09±8.96) mmHg vs. (84.12±11.83) mmHg] time points, the average arterial pressure fluctuation in the experimental group was significantly smaller, and the differ-ence between the two groups was statistically significant (P<0.05). There was no significant difference in blood oxygen saturation be-tween the two groups of patients during anesthesia (P>0.05). The experimental group had higher concentrations of adrenaline and nor.adrenaline during the T1, T2, and T3 time periods, and the difference was statistically significant (P<0.05). The incidence of neurocog-nitive disorders in the experimental group showed a decreasing trend (9.09% vs. 21.21%,OR=0.37,P=0.178), although not statistically significant, it had clinical significance (NNT=9). The levels of IL-6 in the experimental group were lower during the T1, T2, T3, and T4 time periods, and the difference was statistically significant (P<0.05). The COR levels of the experimental group patients were lowerduring the T1, T2, T3, and T4 time periods, and the difference was statistically significant (P<0.05). The experimental group had lowerpostoperative consciousness disorders, VAS scores, and incidence of respiratory complications, although not statistically significant (P> 0.05), the absolute risk reduction deserves clinical attention. There was no significant difference in postoperative recovery delay andICU admission cases, and the difference was not statistically significant (P>0.05).Conclusion TPVB combined with ketamine can al-leviate surgical stress response in elderly patients and improve postoperative recovery quality. |
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