低剂量艾司氯胺酮在胸腔镜肺段切除术中的应用效果OA

Objective To evaluate the effect of low-dose esketamine in video-assisted thoracoscopic surgery segmentectomy.Methods This study included 106 patients who underwent video-assisted thoracoscopic surgery segmentectomy at Leshan People's Hospital from February 2022 to February 2024.Patients were randomly assigned to two different treatment groups using stratified random sampling.The experimental group(53 patients)received a combination of low-dose esketamine and flurbiprofen axetil.After anesthesia induction,flurbiprofen axetil(1 mg/kg)was intravenously administered,followed by esketamine(0.5 mg/kg)before the skin incision.Esketamine was then infused at a rate of 0.25 mg/(kg·h)until skin suturing started.The control group(53 patients)received the same dosage of flurbiprofen axetil(1 mg/kg)intravenously,but instead of esketamine,the same volume of saline was administered before the skin incision and continued until suturing.We compared the two groups regarding hemodynamics[systolic blood pressure(SBP),diastolic blood pressure(DBP),mean arterial pressure(MAP),and heart rate(HR)before anesthesia induction(T0),5 minutes after entering the thoracic cavity(T1),10 minutes after removal of the double-lumen tube(T2)],consumption of sufentanil and flurbiprofen axetil,cognitive function[Mini-Mental State Examination(MMSE)scores before surgery and 1 d,2 d and 3d after extubation],serum levels of interleukin-6(IL-6),calcium/calmodulin-dependent protein kinase Ⅲ(CAMK Ⅲ),5-hydroxytryptamine(5-HT),and brain-derived neurotrophic factor(BDNF),quality of recovery[Quality of Recovery 40-item questionnaire(QoR-40)scores],emotional status[Hospital Anxiety and Depression Scale(HADS)scores],and adverse effects(nausea,vomiting,respiratory depression,dizziness,and skin allergies).Results Comparisons of SBP,DBP,MAP,and HR in the two groups at T0,T1,and T2 showed that they differed significantly across time points(F=19.904,29.923,22.524,and 13.769,respectively;all P<0.05).A significant difference in MAP was observed between the two groups(F=20.099,P<0.05),with the MAP at T2 being higher in the experimental group than in the control group.No significant differences were found between the two groups in SBP,DBP,or HR(F=2.072,0.038,and 0.092,respectively;all P>0.05).The trend of MAP changes differed significantly between the two groups(F=36.736,P<0.05),whereas the trends of SBP,DBP,and HR changes did not differ significantly(F=0.006,0.486,and 0.092,respectively;all P>0.05).Intraoperative and postoperative 24-hour sufentanil consumption,as well as postoperative 24-hour flurbiprofen axetil consumption,were lower in the experimental group than in the control group(all P<0.05).No significant difference was observed in intraoperative flurbiprofen axetil consumption between the two groups(P>0.05).Comparisons of MMSE scores before surgery and at 1,2,and 3 days after extubation demonstrated that MMSE scores differed significantly across time points(F=1830.314,P<0.05)and between the two groups(F=382.161,P<0.05),with higher scores in the experimental group,indicating relatively better cognitive function.The trends of MMSE score changes differed significantly between the two groups(F=125.299,P<0.05).Levels of IL-6 and CAMK III were lower in the experimental group than in the control group(P<0.05),whereas levels of 5-HT and BDNF were higher in the experimental group(P<0.05).The experimental group had lower QoR-40 scores(P<0.05)and higher HADS-A and HADS-D scores than the control group(both P<0.05).There was no significant difference in the overall incidence of adverse reactions between the two groups(P>0.05).Conclusion A low-dose esketamine combined with flurbiprofen axetil opioid-sparing regimen effectively reduces opioid consumption during video-assisted thoracoscopic surgery segmentectomy,improves cognitive function and postoperative recovery,lowers inflammatory markers,enhances mood and quality of recovery,and shows no significant difference in adverse reactions.