PDF(Pubmed)
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).
CONCLUSIONS: 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.
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).
CONCLUSIONS: 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.
摘要：
目的：评价艾氯胺酮联合远端肢体缺血预处理(LIP)对老年胸腔镜肺癌根治术患者的肺保护作用。
方法：这项随机试验是在160例肺癌择期胸腔镜手术患者中进行的，随机分为对照组（注射生理盐水和假LIP），艾氯胺酮组，LIP组,和艾氯胺酮+LIP基团(n=40)。麻醉诱导前,根据分组，患者接受0.5mg/kg艾氯胺酮或10ml生理盐水静脉注射(对照组).LIP是通过在左下肢的the窝上方1-2cm处施加止血带以阻断血流5分钟，间隔5分钟，连续3次，通过在不加压的情况下施加止血带30分钟进行假LIP。在诱导前(T0)计算氧合指数(OI)和肺泡-动脉PO2差值(A-aDO2),在单肺通气（OLV）30分钟（T0.5）和1小时（T1）时，并在双肺通气后1小时（T3）。血清SP-D水平,通过ELISA在T0，T1，T2（OLV的2小时）测量CC-16和TNF-α，T3,术后24h(T4)。记录患者的住院时间和术后肺部并发症。
结果：与对照组相比，其他3组患者的CC-16、SP-D和TNF-α水平显著降低,住院时间缩短,肺部感染和肺不张的发生率较低(均P<0.05)。血清CC-16、SP-D和TNF-α水平,住院,联合治疗组并发症发生率明显低于或短于艾氯胺酮组和LIP组(均P<0.05)。
结论：在接受胸腔镜肺癌根治术的老年患者中，艾氯胺酮联合LIP治疗可通过增强抗炎反应减轻急性肺损伤,缩短术后住院时间,减少肺部并发症，促进患者康复。
方法：这项随机试验是在160例肺癌择期胸腔镜手术患者中进行的，随机分为对照组（注射生理盐水和假LIP），艾氯胺酮组，LIP组,和艾氯胺酮+LIP基团(n=40)。麻醉诱导前,根据分组，患者接受0.5mg/kg艾氯胺酮或10ml生理盐水静脉注射(对照组).LIP是通过在左下肢的the窝上方1-2cm处施加止血带以阻断血流5分钟，间隔5分钟，连续3次，通过在不加压的情况下施加止血带30分钟进行假LIP。在诱导前(T0)计算氧合指数(OI)和肺泡-动脉PO2差值(A-aDO2),在单肺通气（OLV）30分钟（T0.5）和1小时（T1）时，并在双肺通气后1小时（T3）。血清SP-D水平,通过ELISA在T0，T1，T2（OLV的2小时）测量CC-16和TNF-α，T3,术后24h(T4)。记录患者的住院时间和术后肺部并发症。
结果：与对照组相比，其他3组患者的CC-16、SP-D和TNF-α水平显著降低,住院时间缩短,肺部感染和肺不张的发生率较低(均P<0.05)。血清CC-16、SP-D和TNF-α水平,住院,联合治疗组并发症发生率明显低于或短于艾氯胺酮组和LIP组(均P<0.05)。
结论：在接受胸腔镜肺癌根治术的老年患者中，艾氯胺酮联合LIP治疗可通过增强抗炎反应减轻急性肺损伤,缩短术后住院时间,减少肺部并发症，促进患者康复。
