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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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

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

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