低剂量艾司氯胺酮对肺癌根治术患者的肺功能保护效应

doi:10.3969/j.issn.1006-6233.2025.05.029

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摘要 目的: 探究低剂量艾司氯胺酮对肺癌根治术患者术中单肺通气时肺功能的保护效应。方法: 前瞻性选择2022年1月至2023年12月择期行肺癌根治术患者78例,年龄≥60岁,采用随机数字表法分为两组(n=39):艾司氯胺酮组和对照组。艾司氯胺酮组在麻醉诱导期间静脉注射艾司氯胺酮0.2mg/kg,麻醉维持静脉泵注艾司氯胺酮0.15mg·kg^-1·h^-1;对照组予以等体积生理盐水。于入室时(T0)、双腔管插管成功即刻(T1)、单肺通气开始(T2)、手术开始(T3)、单肺通气结束(T4)、术毕(T5)记录心率(HR)和平均动脉压(MAP),并且在T2、T3、T4、T5记录脑电双频指数(BIS)。于插管即刻、单肺通气后30min、术毕计算肺泡动脉氧分压差(A-aDO₂)、呼吸指数(RI)及肺动态顺应性(Cdyn)。于术前、术毕及术后24h取外周静脉血样,测定血清TNF-α、IL-6、IL-10、丙二醛(MDA)和超氧化物歧化酶(SOD)水平。记录术后2h(V1)、6h(V2)、12h(V3)、24h(V4)、48h(V5) VAS评分。结果: 与对照组比较,艾司氯胺酮组在OLV 30min、术毕时Cdyn升高(P>0.05),PA-aO₂、RI降低(P<0.05);与对照组比较,艾司氯胺酮组患者术毕、术后24h血浆TNF-a、IL-10含量降低(P<0.05),在术毕时血浆IL-6降低(P<0.05),在术毕、术后24h血浆丙二醛浓度降低(P<0.05),血浆超氧化物歧化酶活性升高(P>0.05);艾司氯胺酮组术后各时间点 VAS评分及术后48h内PCIA有效按压和总次数均显著降低于对照组(P<0.05)。结论: 在肺癌根治术中单肺通气患者的诱导和术中持续泵入低剂量艾司氯胺酮可以维持血流动力学平稳,抑制肺癌根治术中单肺通气患者的炎症反应和氧化应激反应,对患者的肺功能、术后镇痛具有积极影响。

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关键词 ：肺癌根治术, 艾司氯胺酮, 单肺通气, 肺功能, 炎症反应, 氧化应激反应, 肺保护

Abstract：Objective: To explore the lung-protective effect of low-dose esketamine in patients with single lung ventilation during radical lung cancer surgery. Methods: Prospectively, 78 patients aged ≥60 years who underwent elective radical resection for lung cancer from January 2022 to December 2023 were selected and divided into two groups (n=39 each) using a random number table method: the esketamine group and the control group. In the esketamine group, esketamine was intravenously injected at a dose of 0.2 mg/kg during anesthesia induction, and esketamine was intravenously pumped at a rate of 0.15 mg·kg^-1·h^-1 for anesthesia maintenance; the control group received an equal volume of normal saline. Heart rate (HR) and mean arterial pressure (MAP) were recorded at the time of admission (T0), immediately after successful double-lumen tube intubation (T1), at the start of one-lung ventilation (T2), at the start of surgery (T3), at the end of one-lung ventilation (T4), and at the end of surgery (T5). Bispectral index (BIS) was recorded at T2, T3, T4, and T5. Alveolar-arterial oxygen tension difference (A-aDO₂), respiratory index (RI), and dynamic lung compliance (Cdyn) were calculated immediately after intubation, 30 minutes after one-lung ventilation, and at the end of surgery. Peripheral venous blood samples were collected before surgery, at the end of surgery, and 24 hours after surgery to measure serum levels of tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6), interleukin-10 (IL-10), malondialdehyde (MDA), and superoxide dismutase (SOD). Visual analog scale (VAS) scores were recorded at 2 hours (V1), 6 hours (V2), 12 hours (V3), 24 hours (V4), and 48 hours (V5) after surgery. Results: Compared with the control group, Cdyn was significantly higher in the esketamine group at 30 minutes of one-lung ventilation and at the end of surgery (P>0.05), while PA-aO₂ and RI were significantly lower (P<0.05).Compared with the control group, plasma levels of TNF-α and IL-10 in the esketamine group were significantly lower at the end of surgery and 24 hours after surgery (P<0.05); plasma IL-6 was significantly lower at the end of surgery (P<0.05); plasma MDA concentration was significantly lower at the end of surgery and 24 hours after surgery (P<0.05); plasma SOD activity was significantly higher (P>0.05). VAS scores at all time points after surgery and the effective pressing times and total times of patient-controlled intravenous analgesia (PCIA) within 48 hours after surgery were significantly lower in the esketamine group than in the control group (P<0.05). Conclusion: Intravenous induction and continuous intraoperative infusion of low-dose esketamine in patients undergoing one-lung ventilation for radical resection of lung cancer can maintain hemodynamic stability, inhibit inflammatory and oxidative stress responses, and have positive effects on pulmonary function and postoperative analgesia.

Key words： Lung carcer radical surgery Esketamine Single lung ventilation Lung function Inflammatory response Oxidative stress reaction Lung protection

基金资助:河北省承德市科学技术研究与发展计划项目,(编号:202204A033)

引用本文:

段凤梅, 赵佳慧, 曹雪峰. 低剂量艾司氯胺酮对肺癌根治术患者的肺功能保护效应[J]. 河北医学, 2025, 31(5): 864-870.
DUAN Fengmei, et al. The Protective Effect on Pulmonary Function of Low-Dose Esketamine in Patients Undergoing Radical Resection of Lung Cancer. HeBei Med, 2025, 31(5): 864-870.

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http://www.hbyxzzs.cn/CN/10.3969/j.issn.1006-6233.2025.05.029 或 http://www.hbyxzzs.cn/CN/Y2025/V31/I5/864

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