亚麻醉剂量艾司氯胺酮对胸腔镜肺手术病人术后镇痛的作用OA

Objective To investigate the effect of intraoperative application of subanesthetic doses of esketamine on posto-perative analgesia in patients undergoing thoracoscopic pulmonary resection.Methods A total of 123 patients who were sche-duled to undergo thoracoscopic resection of lung lesions were selected and divided into control group(C group),esketamine induction+intraoperative pump infusion group(S1 group),and esketamine intraoperative pump infusion group(S2 group)using a random number table,with 41 patients in each group.All three groups of patients received total intravenous anesthesia,with sufentanil as the main analgesic drug,and intercostal nerve block combined with patient-controlled intravenous analgesia was used for postopera-tive analgesia.The three groups of patients were observed and compared in terms of the amount of sufentanil used during surgery,cumulative morphine consumption at 4,24,and 48 h after surgery,heart rate and mean arterial pressure at each time point during the surgery,quality of awakening,Visual Analogue Scalepain scores at rest and during coughing at 4,24,and 48 h after surgery,time of the first postoperative analgesic pump pressing,the rate of remedial analgesia,and the incidence rates of the adverse reac-tions such as postoperative nausea and vomiting,chills,delirium,and agitation within 48 h after surgery.Results Compared with the C group,the S1 and S2 groups had a significantly longer time to the first postoperative analgesic pump pressing(F=6.623,P＜0.05);the S1 group had a significantly lower amount of cumulative morphine consumption during surgery and within 24 h after surgery(F=3.292,11.247;P＜0.05),and there was no significant difference between the S2 group and the C group(P＞0.05).There were no significant differences between the three groups in pain score,the rate of remedial analgesia,the quality of postoperative awakening,and the incidence rates of adverse reactions at each time point after surgery(P＞0.05).Conclusion In thoracoscopic pulmonary resection,pre-induction intravenous injection combined with intraoperative continuous pump infusion of esketamine at the subanesthetic dose of 0.3 mg/kg can reduce the amount of analgesic drugs used during surgery and in the early postoperative period,and it can also delay the use of analgesic drugs for the first time after surgery and help to achieve stable intraoperative hemodynamics,without increasing adverse reactions.