亚麻醉剂量艾司氯胺酮在经胸乳入路腔镜甲状腺手术中的应用效果分析

Analysis of the effect of subanesthetic esketamine in endoscopic thyroidectomy through the chest and breast approach

摘要:

目的 探讨亚麻醉剂量艾司氯胺酮在经胸乳入路腔镜甲状腺手术中的应用效果。方法 选择2023年8月－2024年2月于该院接受择期经胸乳入路腔镜甲状腺手术的女性患者68例，采用随机数表法分为艾司氯胺酮组（34例）和对照组（34例）。艾司氯胺酮组给予舒芬太尼0.2 μg/kg联合艾司氯胺酮0.2 mg/kg静脉推注，对照组仅给予舒芬太尼0.4 μg/kg。观察患者入室镇静后（T₀）、诱导后即刻（T₁）、插管前即刻（T₂）、插管后3 min（T₃）、插管后5 min（T₄）、插管后10 min（T₅）、切皮时（T₆）和切皮后5 min（T₇）的收缩压（SBP）、平均动脉压（MAP）和心率（HR），以及T₁、T₂、T₃、T₄、T₅、T₆和T₇时点脑电双频指数（BIS）；比较两组患者术中出血量、麻醉相关情况［苏醒时间、麻醉恢复室（PACU）停留时间和术中血管活性药使用率］、不良反应发生率（苏醒期呛咳反应、诱导后低血压、诱导期心动过速和术后恶心呕吐）和术后疼痛程度。结果 T₂、T₄和T₅时点，艾司氯胺酮组SBP和MAP高于对照组，差异均有统计学意义（P < 0.05），对照组有3例，艾司氯胺酮组有2例患者出现心动过速，但两组患者各时点HR比较，差异无统计学意义（P > 0.05）。艾司氯胺酮组T₂时点BIS明显高于对照组，差异有统计学意义（P < 0.05），其余时点比较，差异无统计学意义（P > 0.05），艾司氯胺酮组血管活性药物中去甲肾上腺素使用率明显低于对照组（P < 0.05），两组患者苏醒时间和PACU停留时间比较，差异均无统计学意义（P > 0.05）。艾司氯胺酮组苏醒期呛咳反应发生率明显低于对照组，T₂和T₅时点低血压发生率明显低于对照组，术后12和24 h恶心呕吐发生率明显低于对照组，差异均有统计学意义（P < 0.05），两组患者术中出血量和诱导期心动过速发生率比较，差异均无统计学意义（P > 0.05）。两组患者术后2 h视觉模拟评分法（VAS）评分比较，差异无统计学意义（P > 0.05），艾司氯胺酮组术后12和24 h VAS评分明显低于对照组，差异均有统计学意义（P < 0.05）。结论 亚麻醉剂量艾司氯胺酮用于经胸乳入路腔镜甲状腺手术，可维持患者血流动力学稳定，降低诱导后低血压发生率，减少术后恶心呕吐和呛咳，且镇痛时间长。值得临床推广应用。

Abstract:

Objective To explore the effects of subanesthetic dose esketamine in endoscopic thyroidectomy through the chest and breast approach.Methods 68 female patients who underwent complete endoscopic thyroidectomy through the chest and breast approach from August 2023 to February 2024 were selected as the study subjects and divided into a control group (34 cases) and esketamine group (34 cases) by random number table method. In the esketamine group, sufentanil 0.2 μg/kg plus esketamine 0.2 mg/kg. In the control group, sufentanil 0.4 μg/kg intravenous infusion was given. Observe the systolic blood pressure (SBP), mean arterial pressure (MAP), and heart rate (HR) of the patients at each time point post-sedated (T₀), immediately after induction (T₁), immediately before intubation (T₂), 3 min after intubation (T₃), 5 min after intubation (T₄), 10 min after intubation (T₅), immediately after skin incision (T₆), 5 min after incision skin (T₇), and electroencephalogram bispectral index (BIS) of electroencephalogram at time points T₁, T₂, T₃, T₄, T₅, T₆ and T₇ time points; The peroperative blood, anesthesia-related conditions [recovery time, PACU stay time and intraoperative utilization rate of vasoactive drugs], the incidence of adverse reactions (choking cough during recovery, incidence of hypotension after induction, tachycardia during induction, postoperative nausea, vomiting) and the degree of postoperative pain were compared between the two groups of patients.Results Compared to the control group, the esketamine group showed significantly higher SBP and MAP at T₂, T₄, and T₅, the differences were statistically significant (P < 0.05); There were 3 cases of tachycardia in the control group and 2 cases in the esketamine group. However, there was no statistically significant difference in HR at each time point between the two group (P > 0.05). The BIS at T₂ time point in the esketamine group was higher than that of the control groups, the difference was statistically significant (P < 0.05), there was no statistically significant difference at the other time points (P > 0.05). The use of vasoactive drugs of norepinephrine in the esketamine group was significantly lower than that of the control group (P < 0.05). There was no statistically significant difference in the recovery time and PACU stay time between the two groups of patients (P > 0.05). The esketamine group exhibited fewer cough reflexes during recovery, lower incidence of hypotension at T₂ and T₅ time points, lower incidences of nausea and vomiting at 12 and 24 h postoperatively, the differences were statistically significant (P < 0.05). There were no statistically significant difference in the peroperative blood and incidence of tachycardia during induction between the two groups of patients (P > 0.05). There was no statistically significant difference in the visual analogue scale (VAS) score of the two groups of patients 2 h after surgery (P > 0.05). The VAS score of the esketamine group at 12 and 24 h after surgery were significantly lower than those of the control group, and the differences were statistically significant (P < 0.05).Conclusion The subanesthetic dose of esketamine used in endoscopic thyroidectomy through the chest and breast approach can maintain hemodynamic stability in patients, reduce the incidence of hypotension after induction, decrease postoperative nausea, vomiting and choking cough, and provide long-lasting analgesia. It is worthy of clinical promotion and application.