南方医科大学学报

南方医科大学学报 ›› 2024, Vol. 44 ›› Issue (3): 484-490.doi: 10.12122/j.issn.1673-4254.2024.03.09

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艾司氯胺酮联合肢体远端缺血预处理对胸腔镜下肺癌根治术老年患者有肺保护作用：160例随机对照试验

杨 杨，刘 刚，欧 毅，鹿文琪   

  1. 蚌埠医科大学第一附属医院麻醉科，安徽 蚌埠 233000
  • 出版日期:2024-03-20 发布日期:2024-04-03

Lung-protective effect of esketamine combined with distal limb ischemic preconditioning in elderly patients undergoing thoracoscopic radical surgery for lung cancer: a randomized controlled trial in 160 cases

YANG Yang, LIU Gang, OU Yi, LU Wenqi   

  1. Department of Anesthesiology, First Affiliated Hospital of Bengbu Medical University, Bengbu 233000, China
  • Online:2024-03-20 Published:2024-04-03

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摘要： 目的 探讨艾司氯胺酮联合肢体远端缺血预处理对行胸腔镜下肺癌根治术的老年患者的肺保护作用。方法 选取我院择期行胸腔镜手术的肺癌患者160例，随机分为对照组（C组，n=40）、艾司氯胺酮组（SK组，n=40）、肢体远端缺血预处理组（R组，n=40）、艾司氯胺酮联合肢体远端缺血预处理组（SKR组，n=40）。在麻醉诱导前，SK组以艾司氯胺酮0.5 mg/kg（稀释成10 mL）静脉注射；R组于左下肢腘窝上1~2 cm绑止血带，阻断一侧下肢血流5 min，然后恢复血流5 min，重复3次；SKR组联合上述两组处理方法；C组静脉给10 mL生理盐水，并仅于左下肢腘窝上1~2 cm绑止血带（无压力）30 min。分别于麻醉诱导前（T0）、单肺通气0.5 h（T0.5）、单肺通气1 h（OLV T1）、双肺通气后1 h（T3），抽取患者动脉血，测定动脉血气分析，计算氧合指数（OI）、肺泡-动脉氧分压差（A-aDO2）；采集静脉血样，ELISA测定法检测诱导前（T0）、OLV 1 h（T1）、OLV 2 h（T2）、双肺后1 h（T3）、术后24 h（T4）时间点患者血清肺表面活性物质（SP-D），克拉拉细胞蛋白16（CC-16），肿瘤坏死因子（TNF-α）浓度；并记录患者的住院时间、术后肺部并发症情况。结果 最终C组有35例患者，R组33例患者，SK组34例患者，SKR组32例患者纳入分析。与C组相比，SK组、R组及SKR组的CC-16、SP-D、TNF-α浓度更低（P<0.05）；与SK组及R组相比，SKR组的CC-16、SP-D、TNF-α浓度更低（P<0.05）；与C组相比，SK组、R组及SKR组住院时间短，肺部感染、肺不张发生率低，且SKR组住院时间较SK组及R组更短，肺部感染、肺不张发生率更低（P<0.05）。结论 艾司氯胺酮联合肢体远端缺血预处理可能通过增强抗炎反应，减轻急性肺损伤，缩短肺癌术后患者住院时间、减少肺部并发症，促进患者术后恢复。

关键词: 艾司氯胺酮；肢体远端缺血预处理；肺癌；肺损伤；肺保护；胸腔镜肺癌根治术

Abstract: Objective To evaluate the effect of esketamine combined with distal limb ischemic preconditioning (LIP) for lung protection in elderly patients undergoing thoracoscopic radical surgery for lung cancer. Methods This randomized trial was conducted in 160 patients undergoing elective thoracoscopic surgery for lung cancer, who were randomized into control group (with saline injection and sham LIP), esketamine group, LIP group, and esketamine + LIP group (n=40). Before anesthesia induction, according to the grouping, the patients received an intravenous injection with 0.5 mg/kg esketamine or 10 ml saline (in control group). LIP was induced by applying a tourniquet 1-2 cm above the popliteal fossa in the left lower limb to block the blood flow for 5 min for 3 times at the interval of 5 min, and sham LIP was performed by applying the tourniquet without pressurization for 30 min. Oxygenation index (OI) and alveolar-arterial PO2 difference (A-aDO2) were calculated before induction (T0), at 30 min (T0.5) and 1 h (T1) of one-lung ventilation (OLV), and at 1 h after two-lung ventilation (T3). Serum levels of SP-D, CC-16 and TNF-α were measured by ELISA at T0, T1, T2 (2 h of OLV), T3, and 24 h after the operation (T4). The length of hospital stay and postoperative pulmonary complications of the patients were recorded. Results Compared with those in the control group, the patients in the other 3 groups had significantly lower CC-16, SP-D and TNF-α levels, shorter hospital stay, and lower incidences of lung infection and lung atelectasis (all P<0.05). Serum CC-16, SP-D and TNF-α levels, hospital stay, incidences of complications were significantly lower or shorter in the combined treatment group than in esketamine group and LIP group (all P<0.05). Conclusion In elderly patients undergoing thoracoscopic radical surgery for lung cancer, treatment with esketamine combined with LIP can alleviate acute lung injury by enhancing anti-inflammatory response to shorten postoperative hospital stay, reduce lung complications and promote the patients' recovery.

Key words: esketamine; distal limb ischemia pretreatment; lung cancer; lung injury; lung protection; thoracoscopic radical lung cancer