首页 期刊 论文 学科刊群 资讯 加盟 关于
EN
image
Article(id=1198602001761268682, tenantId=1146029695717560320, journalId=1189873630562394117, issueId=1198601997155922872, articleNumber=null, orderNo=null, doi=10.11855/j.issn.0577-7402.0337.2023.0718, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=research-article, receivedDate=1677772800000, receivedDateStr=2023-03-03, revisedDate=null, revisedDateStr=null, acceptedDate=1685376000000, acceptedDateStr=2023-05-30, onlineDate=1763698586167, onlineDateStr=2025-11-21, pubDate=1719504000000, pubDateStr=2024-06-28, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1763698586167, onlineIssueDateStr=2025-11-21, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1763698586167, creator=13701087609, updateTime=1763698586167, updator=13701087609, issue=Issue{id=1198601997155922872, tenantId=1146029695717560320, journalId=1189873630562394117, year='2024', volume='49', issue='6', pageStart='611', pageEnd='732', issueExtLink='null', onlineDate='null', pubDate='null', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=0, createTime=1763698585070, creator=13701087609, updateTime=1763698770557, updator=13701087609, preIssue=null, nextIssue=null, ext={EN=IssueExt(id=1198602775211901122, tenantId=1146029695717560320, journalId=1189873630562394117, issueId=1198601997155922872, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1198602775211901123, tenantId=1146029695717560320, journalId=1189873630562394117, issueId=1198601997155922872, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null}, startPage=656, endPage=662, ext={EN=ArticleExt(id=1198602002038092759, articleId=1198602001761268682, tenantId=1146029695717560320, journalId=1189873630562394117, language=EN, title=Application effect of opioid-free postoperative patient-controlled analgesia strategy in thoracic endoscopic surgery, columnId=1190310109000602400, journalTitle=Medical Journal of Chinese People’s Liberation Army, columnName=Clinical Research, runingTitle=null, highlight=null, articleAbstract=

Objective To explore the application effect of opioid-free postoperative patient-controlled analgesia strategy in thoracic endoscopic resection of lung lesions. Methods This study is a single center, double-blind, prospective, open label, randomized controlled trial. Ninety patients with lung surgery under thoracic endoscope in the Second Affiliated Hospital of Chongqing Medical University were selected from November 2021 to April 2023, and divided into three groups, according to the random number table method including esketamine and dexmedetomidine (esKDex group, n=30), sufentanil and dexmedetomidine (sFDex group, n=30) and tramadol and dexmedetomidine (TraDex group, n=30). The incidence of postoperative nausea and vomiting (PONV), vital signs related indicators, visual analogue scale (VAS) score, Ramsay sedation (RSS) score, Bruggrmann comfort scale (BCS) score and mini-mental state examination (MMSE) score were compared among the 3 groups within 48 hours after surgery. Results Within 48 h after surgery, the incidence of PONV in esKDex group was lower than that in sFDex group and TraDex group [10.0%(3/30) vs. 20.0%(6/30) vs. 20.0%(6/30), P<0.001]. The VAS scores in esKDex group and sFDex group at 2 h and 4 h after surgery were lower than those in TraDex group (2 h after surgery: P=0.001, 0.001; 4 h after surgery: P=0.027, 0.024). The VAS scores at 24 h and 48 h after surgery were higher than those in TraDex group (24 h after surgery: P=0.008, 0.029; 48 h after surgery: P=0.005, 0.005). The BCS scores of esKDex group and sFDex group at 24 h and 48 h after surgery were lower than those in TraDex group (24 h after surgery: P=0.017, 0.007; 48 h after surgery: P=0.005, 0.007). There was no significant difference between Ramsay scores and MMSE scores among the three groups within 48 h after surgery (P>0.05). Conclusion The strategy of opioid-free postoperative patient-controlled analgesia (esketamine and dexmedetomidine) can reduce the incidence of PONV under the premise of satisfying the sedation and analgesia of patients after thoracic endoscopic surgery.

, correspAuthors=Xiao-Xia Li, authorNote=null, correspAuthorsNote=
E-mail:
, copyrightStatement=null, copyrightOwner=null, extLink=null, articleAbsUrl=null, sourceXml=null, magXml=null, pdfUrl=null, pdf=null, pdfFileSize=null, pdfExtLink=null, richHtmlUrl=null, mobilePdfUrl=null, reviewReport=null, pdfFirstPage=null, abstractGraph=null, abstractGraphContent=null, abstractVideo=null, citation=null, cebUrl=null, magXmlContent=null, mapNumber=null, authorCompany=null, fund=null, authors=null, authorsList=Wen-Qian Li, Xiao-Xia Li), CN=ArticleExt(id=1198602002402997219, articleId=1198602001761268682, tenantId=1146029695717560320, journalId=1189873630562394117, language=CN, title=零阿片术后自控镇痛策略在胸科腔镜手术中的应用效果, columnId=1190310109164180259, journalTitle=解放军医学杂志, columnName=临床研究, runingTitle=null, highlight=null, articleAbstract=

目的 探讨零阿片术后自控镇痛策略在胸科腔镜肺部病损切除术中的应用效果。方法 本研究为单中心、双盲前瞻性、开放性、随机对照试验。纳入2021年11月-2023年4月重庆医科大学附属第二医院在胸科腔镜下行肺部病损切除术的患者90例，依据随机数字表法分为艾司氯胺酮+右美托咪定(esKDex)组(n=30)、舒芬太尼+右美托咪定(sFDex)组(n=30)、曲马多+右美托咪定(TraDex)组(n=30)。比较3组术后48 h内恶心呕吐(PONV)的发生率、生命体征相关指标、视觉模拟评分法(VAS)评分、BCS舒适评分、Ramsay镇静评分、简易精神状态(MMSE)评分。结果 术后48 h内，esKDex组PONV发生率低于sFDex组及TraDex组，差异有统计学意义[10.0%(3/30) vs. 20.0%(6/30) vs. 20.0%(6/30)，P<0.001]。esKDex组及sFDex组术后2、4 h的VAS评分均低于TraDex组(术后2 h：P=0.001、0.001；术后4 h：P=0.027、0.024)，术后24、48 h的VAS评分均高于TraDex组(术后24 h：P=0.008、0.029；术后48 h：P=0.005、0.005)。esKDex组和sFDex组术后24、48 h的BCS舒适评分均低于TraDex组(术后24 h：P=0.017、0.007；术后48 h：P=0.005、0.007)。3组术后48 h内的Ramsay镇静评分、MMSE评分差异均无统计学意义(P>0.05)。结论 艾司氯胺酮联合右美托咪定的零阿片术后自控镇痛策略在满足胸科腔镜肺部病损切除术术后患者镇静镇痛前提下能降低PONV发生率。

, correspAuthors=李晓霞, authorNote=null, correspAuthorsNote=
李晓霞，E-mail：
, copyrightStatement=null, copyrightOwner=null, extLink=null, articleAbsUrl=null, sourceXml=SfnBRC59LujiulVXlQP5ew==, magXml=hub4Gwb9bWXbk4fHbiEM7A==, pdfUrl=null, pdf=WbI/9QUXSAOG27aq0ARQAQ==, pdfFileSize=938137, pdfExtLink=null, richHtmlUrl=null, mobilePdfUrl=null, reviewReport=null, pdfFirstPage=null, abstractGraph=null, abstractGraphContent=null, abstractVideo=null, citation=null, cebUrl=null, magXmlContent=BKxhHCdG+70Ipfe+8rXaOQ==, mapNumber=null, authorCompany=null, fund=null, authors=

李汶谦，硕士研究生，主要从事零阿片麻醉策略、围手术期镇痛等方面的研究

, authorsList=李汶谦, 李晓霞)}, authors=[Author(id=1198611595489276900, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1198602001761268682, orderNo=0, firstName=null, middleName=null, lastName=null, nameCn=null, orcid=null, stid=null, country=null, authorPic=null, dead=0, email=null, emailSecond=null, emailThird=null, correspondingAuthor=0, authorType=1, ext={EN=AuthorExt(id=1198611595564774376, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1198602001761268682, authorId=1198611595489276900, language=EN, stringName=Wen-Qian Li, firstName=Wen-Qian, middleName=null, lastName=Li, prefix=null, suffix=null, authorComment=null, nameInitials=null, affiliation=null, department=null, xref=null, address=Department of Anesthesiology, the Second Affiliated Hospital of Chongqing Medical University, Chongqing 400010, China, bio=null, bioImg=null, bioContent=null, aboutCorrespAuthor=null), CN=AuthorExt(id=1198611595640271853, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1198602001761268682, authorId=1198611595489276900, language=CN, stringName=李汶谦, firstName=汶谦, middleName=null, lastName=李, prefix=null, suffix=null, authorComment=null, nameInitials=null, affiliation=null, department=null, xref=null, address=重庆医科大学附属第二医院麻醉科，重庆 400010, bio={"content":"

李汶谦，硕士研究生，主要从事零阿片麻醉策略、围手术期镇痛等方面的研究

"}, bioImg=null, bioContent=

李汶谦，硕士研究生，主要从事零阿片麻醉策略、围手术期镇痛等方面的研究

, aboutCorrespAuthor=null)}, companyList=[AuthorCompany(id=1198611595359253470, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1198602001761268682, xref=null, ext=[AuthorCompanyExt(id=1198611595367642079, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1198602001761268682, companyId=1198611595359253470, language=EN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=Department of Anesthesiology, the Second Affiliated Hospital of Chongqing Medical University, Chongqing 400010, China), AuthorCompanyExt(id=1198611595376030688, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1198602001761268682, companyId=1198611595359253470, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=重庆医科大学附属第二医院麻醉科，重庆 400010)])]), Author(id=1198611595703186415, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1198602001761268682, orderNo=1, firstName=null, middleName=null, lastName=null, nameCn=null, orcid=null, stid=null, country=null, authorPic=null, dead=0, email=300465@hospital.cqmu.edu.cn, emailSecond=null, emailThird=null, correspondingAuthor=1, authorType=1, ext={EN=AuthorExt(id=1198611595787072498, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1198602001761268682, authorId=1198611595703186415, language=EN, stringName=Xiao-Xia Li, firstName=Xiao-Xia, middleName=null, lastName=Li, prefix=null, suffix=null, authorComment=null, nameInitials=null, affiliation=null, department=null, xref=*, address=Department of Anesthesiology, the Second Affiliated Hospital of Chongqing Medical University, Chongqing 400010, China, bio=null, bioImg=null, bioContent=null, aboutCorrespAuthor=null), CN=AuthorExt(id=1198611595870958579, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1198602001761268682, authorId=1198611595703186415, language=CN, stringName=李晓霞, firstName=晓霞, middleName=null, lastName=李, prefix=null, suffix=null, authorComment=null, nameInitials=null, affiliation=null, department=null, xref=*, address=重庆医科大学附属第二医院麻醉科，重庆 400010, bio=null, bioImg=null, bioContent=null, aboutCorrespAuthor=null)}, companyList=[AuthorCompany(id=1198611595359253470, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1198602001761268682, xref=null, ext=[AuthorCompanyExt(id=1198611595367642079, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1198602001761268682, companyId=1198611595359253470, language=EN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=Department of Anesthesiology, the Second Affiliated Hospital of Chongqing Medical University, Chongqing 400010, China), AuthorCompanyExt(id=1198611595376030688, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1198602001761268682, companyId=1198611595359253470, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=重庆医科大学附属第二医院麻醉科，重庆 400010)])])], keywords=[Keyword(id=1198611596009370615, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1198602001761268682, language=EN, orderNo=1, keyword=thoracic surgery), Keyword(id=1198611596114228220, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1198602001761268682, language=EN, orderNo=2, keyword=postoperative analgesia), Keyword(id=1198611596172948477, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1198602001761268682, language=EN, orderNo=3, keyword=multimodal analgesia), Keyword(id=1198611596240057342, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1198602001761268682, language=EN, orderNo=4, keyword=opioid-free analgesia strategy), Keyword(id=1198611596307166207, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1198602001761268682, language=CN, orderNo=1, keyword=胸外科手术), Keyword(id=1198611596412022785, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1198602001761268682, language=CN, orderNo=2, keyword=术后镇痛), Keyword(id=1198611596495908866, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1198602001761268682, language=CN, orderNo=3, keyword=多模式镇痛), Keyword(id=1198611596596572166, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1198602001761268682, language=CN, orderNo=4, keyword=零阿片类麻醉策略)], refs=[Reference(id=1198611597863252056, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1198602001761268682, doi=null, pmid=null, pmcid=null, year=2023, volume=51, issue=4, pageStart=397, pageEnd=400, url=null, language=null, rfNumber=[1], rfOrder=0, authorNames=陈秀科, 李东涛, 张福维, journalName=临床军医杂志, refType=null, unstructuredReference=陈秀科, 李东涛, 张福维, 等. 剑突入路胸腔镜手术对前纵隔肿瘤患者应激指标及血清肿瘤标志物影响[J]. 临床军医杂志, 2023, 51(4): 397-400., articleTitle=剑突入路胸腔镜手术对前纵隔肿瘤患者应激指标及血清肿瘤标志物影响, refAbstract=null), Reference(id=1198611597930360926, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1198602001761268682, doi=null, pmid=null, pmcid=null, year=2023, volume=40, issue=12, pageStart=1195, pageEnd=1200, url=null, language=null, rfNumber=[2], rfOrder=1, authorNames=丁凯, journalName=新乡医学院学报, refType=null, unstructuredReference=丁凯. 肺部小结节手术定位研究进展[J]. 新乡医学院学报, 2023, 40(12): 1195-1200., articleTitle=肺部小结节手术定位研究进展, refAbstract=null), Reference(id=1198611598001664098, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1198602001761268682, doi=null, pmid=null, pmcid=null, year=2019, volume=20, issue=3, pageStart=543, pageEnd=554, url=null, language=null, rfNumber=[3], rfOrder=2, authorNames=Bayman EO, Parekh KR, Keech J, journalName=Pain Med, refType=null, unstructuredReference=Bayman EO, Parekh KR, Keech J, et al. Preoperative patient expectations of postoperative pain are associated with moderate to severe acute pain after VATS[J]. Pain Med, 2019, 20(3): 543-554., articleTitle=Preoperative patient expectations of postoperative pain are associated with moderate to severe acute pain after VATS, refAbstract=null), Reference(id=1198611598068772964, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1198602001761268682, doi=null, pmid=null, pmcid=null, year=2022, volume=47, issue=5, pageStart=464, pageEnd=470, url=null, language=null, rfNumber=[4], rfOrder=3, authorNames=陈小红, 李萌萌, 黄璜, journalName=解放军医学杂志, refType=null, unstructuredReference=陈小红, 李萌萌, 黄璜, 等. 右美托咪定对胸外科患者围手术期焦虑的影响[J]. 解放军医学杂志, 2022, 47(5): 464-470., articleTitle=右美托咪定对胸外科患者围手术期焦虑的影响, refAbstract=null), Reference(id=1198611598131687529, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1198602001761268682, doi=null, pmid=null, pmcid=null, year=2017, volume=16, issue=4, pageStart=353, pageEnd=363, url=null, language=null, rfNumber=[5], rfOrder=4, authorNames=Panwar R, Pal S, journalName=Hepatobiliary Pancreat Dis Int, refType=null, unstructuredReference=Panwar R, Pal S. The International Study Group of Pancreatic Surgery definition of delayed gastric emptying and the effects of various surgical modifications on the occurrence of delayed gastric emptying after pancreatoduodenectomy[J]. Hepatobiliary Pancreat Dis Int, 2017, 16(4): 353-363., articleTitle=The International Study Group of Pancreatic Surgery definition of delayed gastric emptying and the effects of various surgical modifications on the occurrence of delayed gastric emptying after pancreatoduodenectomy, refAbstract=null), Reference(id=1198611598207185006, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1198602001761268682, doi=null, pmid=null, pmcid=null, year=2018, volume=130, issue=9-10, pageStart=356, pageEnd=366, url=null, language=null, rfNumber=[6], rfOrder=5, authorNames=Trimmel H, Helbok R, Staudinger T, journalName=Wien Klin Wochenschr, refType=null, unstructuredReference=Trimmel H, Helbok R, Staudinger T, et al. S(+)-ketamine: current trends in emergency and intensive care medicine[J]. Wien Klin Wochenschr, 2018, 130(9-10): 356-366., articleTitle=S(+)-ketamine: current trends in emergency and intensive care medicine, refAbstract=null), Reference(id=1198611598395928690, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1198602001761268682, doi=null, pmid=null, pmcid=null, year=2023, volume=51, issue=4, pageStart=424, pageEnd=426, url=null, language=null, rfNumber=[7], rfOrder=6, authorNames=牛莉, 韩焕芝, 孙静静, journalName=临床军医杂志, refType=null, unstructuredReference=牛莉, 韩焕芝, 孙静静, 等. 无痛分娩中应用不同剂量艾司氯胺酮效果及对产后抑郁影响[J]. 临床军医杂志, 2023, 51(4): 424-426., articleTitle=无痛分娩中应用不同剂量艾司氯胺酮效果及对产后抑郁影响, refAbstract=null), Reference(id=1198611598467231865, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1198602001761268682, doi=null, pmid=null, pmcid=null, year=2000, volume=93, issue=2, pageStart=382, pageEnd=394, url=null, language=null, rfNumber=[8], rfOrder=7, authorNames=Ebert TJ, Hall JE, Barney JA, journalName=Anesthesiology, refType=null, unstructuredReference=Ebert TJ, Hall JE, Barney JA, et al. The effects of increasing plasma concentrations of dexmedetomidine in humans[J]. Anesthesiology, 2000, 93(2): 382-394., articleTitle=The effects of increasing plasma concentrations of dexmedetomidine in humans, refAbstract=null), Reference(id=1198611598559506557, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1198602001761268682, doi=null, pmid=null, pmcid=null, year=2023, volume=48, issue=11, pageStart=1267, pageEnd=1275, url=null, language=null, rfNumber=[9], rfOrder=8, authorNames=丁允莹, 嵇富海, 彭科, journalName=解放军医学杂志, refType=null, unstructuredReference=丁允莹, 嵇富海, 彭科. 右美托咪定的器官保护作用及其机制概述[J]. 解放军医学杂志, 2023, 48(11): 1267-1275., articleTitle=右美托咪定的器官保护作用及其机制概述, refAbstract=null), Reference(id=1198611598635004031, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1198602001761268682, doi=null, pmid=null, pmcid=null, year=2010, volume=31, issue=6, pageStart=769, pageEnd=780, url=null, language=null, rfNumber=[10], rfOrder=9, authorNames=Haynes D, Baumann MH, journalName=Semin Respir Crit Care Med, refType=null, unstructuredReference=Haynes D, Baumann MH. Management of pneumothorax[J]. Semin Respir Crit Care Med, 2010, 31(6): 769-780., articleTitle=Management of pneumothorax, refAbstract=null), Reference(id=1198611598714695817, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1198602001761268682, doi=null, pmid=null, pmcid=null, year=2021, volume=68, issue=7, pageStart=1057, pageEnd=1063, url=null, language=null, rfNumber=[11], rfOrder=10, authorNames=Darvall J, Handscombe M, Maat B, journalName=Can J Anaesth, refType=null, unstructuredReference=Darvall J, Handscombe M, Maat B, et al. Interpretation of the four risk factors for postoperative nausea and vomiting in the Apfel simplified risk score: an analysis of published studies[J]. Can J Anaesth, 2021, 68(7): 1057-1063., articleTitle=Interpretation of the four risk factors for postoperative nausea and vomiting in the Apfel simplified risk score: an analysis of published studies, refAbstract=null), Reference(id=1198611598790193292, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1198602001761268682, doi=null, pmid=null, pmcid=null, year=2020, volume=39, issue=1, pageStart=45, pageEnd=51, url=null, language=null, rfNumber=[12], rfOrder=11, authorNames=Klenke S, de Vries GJ, Schiefer L, journalName=Anaesth Crit Care Pain Med, refType=null, unstructuredReference=Klenke S, de Vries GJ, Schiefer L, et al. Genetic contribution to PONV risk[J]. Anaesth Crit Care Pain Med, 2020, 39(1): 45-51., articleTitle=Genetic contribution to PONV risk, refAbstract=null), Reference(id=1198611598857302159, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1198602001761268682, doi=null, pmid=null, pmcid=null, year=2001, volume=38, issue=6, pageStart=644, pageEnd=647, url=null, language=null, rfNumber=[13], rfOrder=12, authorNames=Li SF, Greenwald PW, Gennis P, journalName=Ann Emerg Med, refType=null, unstructuredReference=Li SF, Greenwald PW, Gennis P, et al. Effect of age on acute pain perception of a standardized stimulus in the emergency department[J]. Ann Emerg Med, 2001, 38(6): 644-647., articleTitle=Effect of age on acute pain perception of a standardized stimulus in the emergency department, refAbstract=null), Reference(id=1198611598916022423, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1198602001761268682, doi=null, pmid=null, pmcid=null, year=1986, volume=27, issue=1, pageStart=117, pageEnd=126, url=null, language=null, rfNumber=[14], rfOrder=13, authorNames=Jensen MP, Karoly P, Braver S, journalName=Pain, refType=null, unstructuredReference=Jensen MP, Karoly P, Braver S. The measurement of clinical pain intensity: a comparison of six methods[J]. Pain, 1986, 27(1): 117-126., articleTitle=The measurement of clinical pain intensity: a comparison of six methods, refAbstract=null), Reference(id=1198611598978936987, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1198602001761268682, doi=null, pmid=null, pmcid=null, year=2011, volume=63, issue=null, pageStart=S240, pageEnd=S252, url=null, language=null, rfNumber=[15], rfOrder=14, authorNames=Hawker GA, Mian S, Kendzerska T, journalName=Arthritis Care Res (Hoboken), refType=null, unstructuredReference=Hawker GA, Mian S, Kendzerska T, et al. Measures of adult pain: visual analog scale for pain (VAS pain), numeric rating scale for pain (NRS pain), McGill pain questionnaire (MPQ), short-form McGill pain questionnaire (SF-MPQ), chronic pain grade scale (CPGS), short form-36 bodily pain scale (SF-36 BPS), and measure of intermittent and constant osteoarthritis pain (ICOAP)[J]. Arthritis Care Res (Hoboken), 2011, 63(): S240-S252., articleTitle=Measures of adult pain: visual analog scale for pain (VAS pain), numeric rating scale for pain (NRS pain), McGill pain questionnaire (MPQ), short-form McGill pain questionnaire (SF-MPQ), chronic pain grade scale (CPGS), short form-36 bodily pain scale (SF-36 BPS), and measure of intermittent and constant osteoarthritis pain (ICOAP), refAbstract=Suppl 11), Reference(id=1198611599062823071, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1198602001761268682, doi=null, pmid=null, pmcid=null, year=2018, volume=36, issue=4, pageStart=707, pageEnd=714, url=null, language=null, rfNumber=[16], rfOrder=15, authorNames=Karcioglu O, Topacoglu H, Dikme O, journalName=Am J Emerg Med, refType=null, unstructuredReference=Karcioglu O, Topacoglu H, Dikme O, et al. A systematic review of the pain scales in adults: which to use?[J]. Am J Emerg Med, 2018, 36(4): 707-714., articleTitle=A systematic review of the pain scales in adults: which to use?, refAbstract=null), Reference(id=1198611599150903464, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1198602001761268682, doi=null, pmid=null, pmcid=null, year=2019, volume=111, issue=null, pageStart=443, pageEnd=451, url=null, language=null, rfNumber=[17], rfOrder=16, authorNames=Subedi M, Bajaj S, Kumar MS, journalName=Biomed Pharmacother, refType=null, unstructuredReference=Subedi M, Bajaj S, Kumar MS, et al. An overview of tramadol and its usage in pain management and future perspective[J]. Biomed Pharmacother, 2019, 111: 443-451., articleTitle=An overview of tramadol and its usage in pain management and future perspective, refAbstract=null), Reference(id=1198611599238983851, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1198602001761268682, doi=null, pmid=null, pmcid=null, year=2010, volume=41, issue=4, pageStart=671, pageEnd=676, url=null, language=null, rfNumber=[18], rfOrder=17, authorNames=Black PA, Cox SK, Macek M, journalName=J Zoo Wildl Med, refType=null, unstructuredReference=Black PA, Cox SK, Macek M, et al. Pharmacokinetics of tramadol hydrochloride and its metabolite O-desmethyltramadol in peafowl (Pavo cristatus)[J]. J Zoo Wildl Med, 2010, 41(4): 671-676., articleTitle=Pharmacokinetics of tramadol hydrochloride and its metabolite O-desmethyltramadol in peafowl (Pavo cristatus), refAbstract=null), Reference(id=1198611599318675632, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1198602001761268682, doi=null, pmid=null, pmcid=null, year=2019, volume=16, issue=11, pageStart=1439, pageEnd=1446, url=null, language=null, rfNumber=[19], rfOrder=18, authorNames=Oh SK, Lee IO, Lim BG, journalName=Int J Med Sci, refType=null, unstructuredReference=Oh SK, Lee IO, Lim BG, et al. Comparison of the analgesic effect of sufentanil versus fentanyl in intravenous patient-controlled analgesia after total laparoscopic hysterectomy: a randomized, double-blind, prospective study[J]. Int J Med Sci, 2019, 16(11): 1439-1446., articleTitle=Comparison of the analgesic effect of sufentanil versus fentanyl in intravenous patient-controlled analgesia after total laparoscopic hysterectomy: a randomized, double-blind, prospective study, refAbstract=null), Reference(id=1198611599394173106, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1198602001761268682, doi=null, pmid=null, pmcid=null, year=2017, volume=126, issue=5, pageStart=938, pageEnd=951, url=null, language=null, rfNumber=[20], rfOrder=19, authorNames=Bayman EO, Parekh KR, Keech J, journalName=Anesthesiology, refType=null, unstructuredReference=Bayman EO, Parekh KR, Keech J, et al. A prospective study of chronic pain after thoracic surgery[J]. Anesthesiology, 2017, 126(5): 938-951., articleTitle=A prospective study of chronic pain after thoracic surgery, refAbstract=null), Reference(id=1198611599499030713, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1198602001761268682, doi=null, pmid=null, pmcid=null, year=2017, volume=36, issue=null, pageStart=118, pageEnd=122, url=null, language=null, rfNumber=[21], rfOrder=20, authorNames=Chen Z, Tang R, Zhang R, journalName=J Clin Anesth, refType=null, unstructuredReference=Chen Z, Tang R, Zhang R, et al. Effects of dexmedetomidine administered for postoperative analgesia on sleep quality in patients undergoing abdominal hysterectomy[J]. J Clin Anesth, 2017, 36: 118-122., articleTitle=Effects of dexmedetomidine administered for postoperative analgesia on sleep quality in patients undergoing abdominal hysterectomy, refAbstract=null), Reference(id=1198611599603888316, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1198602001761268682, doi=null, pmid=null, pmcid=null, year=2003, volume=98, issue=2, pageStart=428, pageEnd=436, url=null, language=null, rfNumber=[22], rfOrder=21, authorNames=Nelson LE, Lu J, Guo T, journalName=Anesthesiology, refType=null, unstructuredReference=Nelson LE, Lu J, Guo T, et al. The alpha2-adrenoceptor agonist dexmedetomidine converges on an endogenous sleep-promoting pathway to exert its sedative effects[J]. Anesthesiology, 2003, 98(2): 428-436., articleTitle=The alpha2-adrenoceptor agonist dexmedetomidine converges on an endogenous sleep-promoting pathway to exert its sedative effects, refAbstract=null), Reference(id=1198611599704551614, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1198602001761268682, doi=null, pmid=null, pmcid=null, year=2000, volume=90, issue=3, pageStart=699, pageEnd=705, url=null, language=null, rfNumber=[23], rfOrder=22, authorNames=Hall JE, Uhrich TD, Barney JA, journalName=Anesth Analg, refType=null, unstructuredReference=Hall JE, Uhrich TD, Barney JA, et al. Sedative, amnestic, and analgesic properties of small-dose dexmedetomidine infusions[J]. Anesth Analg, 2000, 90(3): 699-705., articleTitle=Sedative, amnestic, and analgesic properties of small-dose dexmedetomidine infusions, refAbstract=null), Reference(id=1198611599788437698, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1198602001761268682, doi=null, pmid=null, pmcid=null, year=2016, volume=55, issue=9, pageStart=1059, pageEnd=1077, url=null, language=null, rfNumber=[24], rfOrder=23, authorNames=Peltoniemi MA, Hagelberg NM, Olkkola KT, journalName=Clin Pharmacokinet, refType=null, unstructuredReference=Peltoniemi MA, Hagelberg NM, Olkkola KT, et al. Ketamine: a review of clinical pharmacokinetics and pharmacodynamics in anesthesia and pain therapy[J]. Clin Pharmacokinet, 2016, 55(9): 1059-1077., articleTitle=Ketamine: a review of clinical pharmacokinetics and pharmacodynamics in anesthesia and pain therapy, refAbstract=null), Reference(id=1198611599868129475, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1198602001761268682, doi=null, pmid=null, pmcid=null, year=2021, volume=35, issue=2, pageStart=109, pageEnd=123, url=null, language=null, rfNumber=[25], rfOrder=24, authorNames=Jelen LA, Young AH, Stone JM, journalName=J Psychopharmacol, refType=null, unstructuredReference=Jelen LA, Young AH, Stone JM. Ketamine: A tale of two enantiomers[J]. J Psychopharmacol, 2021, 35(2): 109-123., articleTitle=Ketamine: A tale of two enantiomers, refAbstract=null), Reference(id=1198611599977181383, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1198602001761268682, doi=null, pmid=null, pmcid=null, year=2022, volume=38, issue=17, pageStart=2968, pageEnd=2978, url=null, language=null, rfNumber=[26], rfOrder=25, authorNames=李汶谦, 李晓霞, journalName=现代医药卫生, refType=null, unstructuredReference=李汶谦, 李晓霞. 胸外科手术术后镇痛研究进展[J]. 现代医药卫生, 2022, 38(17): 2968-2978., articleTitle=胸外科手术术后镇痛研究进展, refAbstract=null), Reference(id=1198611600052678858, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1198602001761268682, doi=null, pmid=null, pmcid=null, year=2019, volume=38, issue=2, pageStart=111, pageEnd=112, url=null, language=null, rfNumber=[27], rfOrder=26, authorNames=Harkouk H, Fletcher D, Beloeil H, journalName=Anaesth Crit Care Pain Med, refType=null, unstructuredReference=Harkouk H, Fletcher D, Beloeil H. Opioid free anaesthesia: myth or reality?[J]. Anaesth Crit Care Pain Med, 2019, 38(2): 111-112., articleTitle=Opioid free anaesthesia: myth or reality?, refAbstract=null), Reference(id=1198611600123982028, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1198602001761268682, doi=null, pmid=null, pmcid=null, year=2017, volume=31, issue=4, pageStart=441, pageEnd=443, url=null, language=null, rfNumber=[28], rfOrder=27, authorNames=Mulier J, Dekock M, journalName=Best Pract Res Clin Anaesthesiol, refType=null, unstructuredReference=Mulier J, Dekock M. Opioid free general anesthesia, a new paradigm?[J]. Best Pract Res Clin Anaesthesiol, 2017, 31(4): 441-443., articleTitle=Opioid free general anesthesia, a new paradigm?, refAbstract=null)], funds=null, companyList=[AuthorCompany(id=1198611595359253470, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1198602001761268682, xref=null, ext=[AuthorCompanyExt(id=1198611595367642079, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1198602001761268682, companyId=1198611595359253470, language=EN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=Department of Anesthesiology, the Second Affiliated Hospital of Chongqing Medical University, Chongqing 400010, China), AuthorCompanyExt(id=1198611595376030688, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1198602001761268682, companyId=1198611595359253470, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=重庆医科大学附属第二医院麻醉科，重庆 400010)])], figs=[ArticleFig(id=1198611596781121550, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1198602001761268682, language=EN, label=Tab.1, caption=

Comparison of the general data among three groups of patients with lung surgery under thoracic endoscope

, figureFileSmall=null, figureFileBig=null, tableContent=
项目

esKDex组
(n=30)

sFDex组
(n=30)

TraDex组
(n=30)

P
年龄(岁, $\bar{x}±s$)48.1±10.750.4±10.450.8±23.10.175
性别[例(%)]0.957
男15(50.0)16(53.3)16(53.3)
女15(50.0)14(46.6)14(46.6)
疾病病种[例(%)]0.223
肺结节(良/恶性)24(80.0)22(73.3)23(76.7)
肺大疱6(20.0)8(26.7)7(23.3)
手术方式[例(%)]0.223
肺楔形切除术9(30.0)8(26.7)7(23.3)
肺段切除术21(70.0)22(73.3)23(76.7)
ASA分级[例(%)]0.764
Ⅰ级02(6.6)1(3.3)
Ⅱ级27(90.0)23(76.6)23(76.6)
Ⅲ级3(10.0)5(16.6)6(20.0)
BMI(kg/m2, $\bar{x}±s$)23.3±2.722.2±2.823.1±2.60.230
), ArticleFig(id=1198611596856619028, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1198602001761268682, language=CN, label=表1, caption=

3组胸科腔镜肺部病损切除术患者一般资料比较

, figureFileSmall=null, figureFileBig=null, tableContent=
项目

esKDex组
(n=30)

sFDex组
(n=30)

TraDex组
(n=30)

P
年龄(岁, $\bar{x}±s$)48.1±10.750.4±10.450.8±23.10.175
性别[例(%)]0.957
男15(50.0)16(53.3)16(53.3)
女15(50.0)14(46.6)14(46.6)
疾病病种[例(%)]0.223
肺结节(良/恶性)24(80.0)22(73.3)23(76.7)
肺大疱6(20.0)8(26.7)7(23.3)
手术方式[例(%)]0.223
肺楔形切除术9(30.0)8(26.7)7(23.3)
肺段切除术21(70.0)22(73.3)23(76.7)
ASA分级[例(%)]0.764
Ⅰ级02(6.6)1(3.3)
Ⅱ级27(90.0)23(76.6)23(76.6)
Ⅲ级3(10.0)5(16.6)6(20.0)
BMI(kg/m2, $\bar{x}±s$)23.3±2.722.2±2.823.1±2.60.230
), ArticleFig(id=1198611596944699417, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1198602001761268682, language=EN, label=Tab.2, caption=

Comparison of the vital signs and opioid use during surgery among three groups of patients with lung surgery under thoracic endoscope ($\bar{x}±s$)

, figureFileSmall=null, figureFileBig=null, tableContent=
项目esKDex组(n=30)sFDex组(n=30)TraDex组(n=30)P
术中阿片类药物使用量
舒芬太尼(μg)37.5±6.938.5±4.836.3±6.10.380
瑞芬太尼(mg)1.8±0.91.7±0.62.1±0.70.070
HR(次/min)
T177.0±12.879.7±13.878.3±9.60.699
T294.7±5.794.5±3.794.4±3.50.968
T384.9±4.785.7±4.487.4±4.60.105
T475.0±4.676.0±5.174.8±3.70.552
T594.7±5.495.5±4.095.2±3.50.775
MAP(mmHg)
T199.6±8.896.2±8.895.3±10.00.859
T286.8±9.184.2±10.084.5±10.20.532
T382.5±10.382.7±8.380.1±10.80.547
T489.2±11.292.0±9.991.5±8.60.516
T596.4±8.793.8±9.292.6±8.80.251
SpO2(%)
T197.8±0.897.8±0.898.1±0.80.287
T299.3±0.899.4±0.899.5±0.50.669
T399.4±0.799.6±0.899.2±0.40.104
T499.3±0.799.4±0.799.5±0.50.342
T598.0±0.898.1±0.898.1±0.90.776
), ArticleFig(id=1198611597057945632, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1198602001761268682, language=CN, label=表2, caption=

3组胸科腔镜肺部病损切除术患者术中生命体征及阿片类药物使用量比较($\bar{x}±s$)

, figureFileSmall=null, figureFileBig=null, tableContent=
项目esKDex组(n=30)sFDex组(n=30)TraDex组(n=30)P
术中阿片类药物使用量
舒芬太尼(μg)37.5±6.938.5±4.836.3±6.10.380
瑞芬太尼(mg)1.8±0.91.7±0.62.1±0.70.070
HR(次/min)
T177.0±12.879.7±13.878.3±9.60.699
T294.7±5.794.5±3.794.4±3.50.968
T384.9±4.785.7±4.487.4±4.60.105
T475.0±4.676.0±5.174.8±3.70.552
T594.7±5.495.5±4.095.2±3.50.775
MAP(mmHg)
T199.6±8.896.2±8.895.3±10.00.859
T286.8±9.184.2±10.084.5±10.20.532
T382.5±10.382.7±8.380.1±10.80.547
T489.2±11.292.0±9.991.5±8.60.516
T596.4±8.793.8±9.292.6±8.80.251
SpO2(%)
T197.8±0.897.8±0.898.1±0.80.287
T299.3±0.899.4±0.899.5±0.50.669
T399.4±0.799.6±0.899.2±0.40.104
T499.3±0.799.4±0.799.5±0.50.342
T598.0±0.898.1±0.898.1±0.90.776
), ArticleFig(id=1198611597171191848, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1198602001761268682, language=EN, label=Tab.3, caption=

Comparison of Apfel risk assessment and risk factors among three groups of patients with lung surgery under thoracic endoscope

, figureFileSmall=null, figureFileBig=null, tableContent=
项目

esKDex组
(n=30)

sFDex组
(n=30)

TraDex组(n=30)P
Apfel风险评分(分, $\bar{x}±s$)1.4±0.92.0±1.02.0±1.0<0.001
Apfel风险评分占比[例(%)]
0分7(23.3)00<0.001
1分7(23.3)13(43.3)15(50.0)0.023
2分14(46.6)4(13.3)1(3.3)<0.001
3分2(6.6)12(40.0)13(43.3)<0.001
4分01(3.3)1(3.3)<0.001
Apfel风险评分风险因素[例(%)]
女性15(50.0)14(46.6)14(46.6)0.673
非吸烟状态22(73.3)16(53.3)15(50.0)0.092
既往PONV历史4(13.3)1(3.3)1(3.3)<0.001
术后阿片类药物的使用a030(100.0)30(100.0)<0.001
), ArticleFig(id=1198611597259272240, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1198602001761268682, language=CN, label=表3, caption=

3组胸科腔镜肺部病损切除术患者Apfel评分及PONV高危因素比较

, figureFileSmall=null, figureFileBig=null, tableContent=
项目

esKDex组
(n=30)

sFDex组
(n=30)

TraDex组(n=30)P
Apfel风险评分(分, $\bar{x}±s$)1.4±0.92.0±1.02.0±1.0<0.001
Apfel风险评分占比[例(%)]
0分7(23.3)00<0.001
1分7(23.3)13(43.3)15(50.0)0.023
2分14(46.6)4(13.3)1(3.3)<0.001
3分2(6.6)12(40.0)13(43.3)<0.001
4分01(3.3)1(3.3)<0.001
Apfel风险评分风险因素[例(%)]
女性15(50.0)14(46.6)14(46.6)0.673
非吸烟状态22(73.3)16(53.3)15(50.0)0.092
既往PONV历史4(13.3)1(3.3)1(3.3)<0.001
术后阿片类药物的使用a030(100.0)30(100.0)<0.001
), ArticleFig(id=1198611597334769718, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1198602001761268682, language=EN, label=Tab.4, caption=

Comparison of PONV details 48 hours after operation among three groups of patients with lung surgery under thoracic endoscope [n(%)]

, figureFileSmall=null, figureFileBig=null, tableContent=
组别

术后
0~2 h

术后
4~8 h

术后
8~16 h

术后
16~24 h

术后
24~48 h

esKDex组01(3.3)1(3.3)1(3.3)0
sFDex组1(3.3)03(10.0)2(6.6)0
TraDex组1(3.3)2(6.6)3(10.0)00
), ArticleFig(id=1198611597414461499, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1198602001761268682, language=CN, label=表4, caption=

3组胸科腔镜肺部病损切除术患者术后48 h内PONV发生情况比较[例(%)]

, figureFileSmall=null, figureFileBig=null, tableContent=
组别

术后
0~2 h

术后
4~8 h

术后
8~16 h

术后
16~24 h

术后
24~48 h

esKDex组01(3.3)1(3.3)1(3.3)0
sFDex组1(3.3)03(10.0)2(6.6)0
TraDex组1(3.3)2(6.6)3(10.0)00
), ArticleFig(id=1198611597464793154, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1198602001761268682, language=EN, label=Tab.5, caption=

Comparison of VAS, BCS, Ramsay, MMSE scores at 48 hours after operation among three groups of patients with lung surgery under thoracic endoscope ($\bar{x}±s$)

, figureFileSmall=null, figureFileBig=null, tableContent=
项目

esKDex组
(n=30)

sFDex组
(n=30)

TraDex组
(n=30)

P
VAS评分
2 h0.8±0.8(2)0.7±1.0(2)1.6±0.60.002
4 h1.1±0.8(1)1.2±0.9(1)1.6±0.70.007
8 h1.2±0.71.3±0.61.5±0.60.058
16 h1.6±0.71.5±0.81.3±0.50.366
24 h1.6±0.7(2)1.5±0.6(1)1.2±0.40.022
48 h1.6±0.6(2)1.5±0.5(2)1.1±0.40.006
BCS舒适评分
2 h2.2±0.82.2±1.12.2±0.70.739
4 h2.0±0.71.8±0.72.0±0.60.431
8 h2.0±0.51.8±0.52.0±0.50.470
16 h1.8±0.61.6±0.62.0±0.50.078
24 h1.8±0.6(1)1.7±0.2(2)2.1±0.50.006
48 h1.7±0.5(2)1.7±0.4(2)2.1±0.50.004
Ramsay镇静评分
2 h2.0±0.22.0±0.42.0±0.20.576
4 h2.0±0.22.0±0.22.0±0.30.772
8 h2.0±0.02.0±0.21.9±0.30.360
16 h2.0±0.02.0±0.22.0±0.20.603
24 h2.0±0.22.0±0.22.0±0.00.603
48 h2.0±0.02.0±0.02.0±0.01.000
MMSE评分
2 h28.3±1.228.4±1.228.1±1.10.657
4 h28.6±1.228.4±1.328.7±1.20.990
8 h28.3±1.228.4±1.128.5±1.30.580
16 h28.6±1.328.5±1.228.0±1.00.622
24 h28.2±1.228.3±1.228.5±1.00.499
48 h28.2±1.228.5±1.128.5±1.10.364
), ArticleFig(id=1198611597536096326, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1198602001761268682, language=CN, label=表5, caption=

3组胸科腔镜肺部病损切除术患者术后48 h VAS评分、BCS舒适评分、Ramsay镇静评分、MMSE评分比较(分，$\bar{x}±s$)

, figureFileSmall=null, figureFileBig=null, tableContent=
项目

esKDex组
(n=30)

sFDex组
(n=30)

TraDex组
(n=30)

P
VAS评分
2 h0.8±0.8(2)0.7±1.0(2)1.6±0.60.002
4 h1.1±0.8(1)1.2±0.9(1)1.6±0.70.007
8 h1.2±0.71.3±0.61.5±0.60.058
16 h1.6±0.71.5±0.81.3±0.50.366
24 h1.6±0.7(2)1.5±0.6(1)1.2±0.40.022
48 h1.6±0.6(2)1.5±0.5(2)1.1±0.40.006
BCS舒适评分
2 h2.2±0.82.2±1.12.2±0.70.739
4 h2.0±0.71.8±0.72.0±0.60.431
8 h2.0±0.51.8±0.52.0±0.50.470
16 h1.8±0.61.6±0.62.0±0.50.078
24 h1.8±0.6(1)1.7±0.2(2)2.1±0.50.006
48 h1.7±0.5(2)1.7±0.4(2)2.1±0.50.004
Ramsay镇静评分
2 h2.0±0.22.0±0.42.0±0.20.576
4 h2.0±0.22.0±0.22.0±0.30.772
8 h2.0±0.02.0±0.21.9±0.30.360
16 h2.0±0.02.0±0.22.0±0.20.603
24 h2.0±0.22.0±0.22.0±0.00.603
48 h2.0±0.02.0±0.02.0±0.01.000
MMSE评分
2 h28.3±1.228.4±1.228.1±1.10.657
4 h28.6±1.228.4±1.328.7±1.20.990
8 h28.3±1.228.4±1.128.5±1.30.580
16 h28.6±1.328.5±1.228.0±1.00.622
24 h28.2±1.228.3±1.228.5±1.00.499
48 h28.2±1.228.5±1.128.5±1.10.364
), ArticleFig(id=1198611597607399497, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1198602001761268682, language=EN, label=Tab.6, caption=

Comparison of postoperative vital signs among three groups of patients with lung surgery under thoracic endoscope ($\bar{x}±s$)

, figureFileSmall=null, figureFileBig=null, tableContent=
项目

esKDex组
(n=30)

sFDex组
(n=30)

TraDex组
(n=30)

P
HR(次/min)
2 h81.7±10.479.7±10.780.6±10.50.770
4 h79.5±9.677.3±12.179.5±12.40.113
8 h79.2±10.677.7±10.679.7±2.30.875
16 h83.0±13.575.1±9.783.4±10.90.051
24 h83.0±13.478.6±12.680.1±12.30.387
48 h81.9±8.678.2±11.283.0±11.10.225
RR(次/min)
2 h18.4±2.217.9±3.219.2±1.70.523
4 h18.0±2.018.0±2.519.1±1.20.097
8 h18.8±2.517.6±2.519.1±1.20.200
416 h18.2±2.318.1±3.219.1±2.10.428
24 h18.3±2.817.5±3.219.0±1.70.506
48 h18.0±2.1(1)18.0±2.8(1)19.4±1.40.020
MAP(mmHg)
2 h87.8±10.7(1)90.0±11.8(1)91.3±11.40.015
4 h88.6±11.888.3±10.492.4±8.90.241
8 h83.1±9.984.0±13.389.0±10.20.097
16 h86.9±11.489.0±11.186.9±9.60.605
24 h87.4±9.687.7±13.891.7±10.50.830
48 h86.7±8.786.5±10.691.3±9.30.064
SpO2(%)
2 h97.4±1.897.4±1.897.3±2.20.845
4 h97.4±1.597.0±1.996.9±4.80.361
8 h97.2±1.697.3±1.697.6±2.00.458
16 h97.6±1.597.3±1.997.6±2.70.467
24 h97.8±1.597.5±1.697.4±3.60.469
48 h98.0±1.198.0±1.598.1±1.40.978
), ArticleFig(id=1198611597682896975, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1198602001761268682, language=CN, label=表6, caption=

3组胸科腔镜肺部病损切除术患者术后生命体征比较($\bar{x}±s$)

, figureFileSmall=null, figureFileBig=null, tableContent=
项目

esKDex组
(n=30)

sFDex组
(n=30)

TraDex组
(n=30)

P
HR(次/min)
2 h81.7±10.479.7±10.780.6±10.50.770
4 h79.5±9.677.3±12.179.5±12.40.113
8 h79.2±10.677.7±10.679.7±2.30.875
16 h83.0±13.575.1±9.783.4±10.90.051
24 h83.0±13.478.6±12.680.1±12.30.387
48 h81.9±8.678.2±11.283.0±11.10.225
RR(次/min)
2 h18.4±2.217.9±3.219.2±1.70.523
4 h18.0±2.018.0±2.519.1±1.20.097
8 h18.8±2.517.6±2.519.1±1.20.200
416 h18.2±2.318.1±3.219.1±2.10.428
24 h18.3±2.817.5±3.219.0±1.70.506
48 h18.0±2.1(1)18.0±2.8(1)19.4±1.40.020
MAP(mmHg)
2 h87.8±10.7(1)90.0±11.8(1)91.3±11.40.015
4 h88.6±11.888.3±10.492.4±8.90.241
8 h83.1±9.984.0±13.389.0±10.20.097
16 h86.9±11.489.0±11.186.9±9.60.605
24 h87.4±9.687.7±13.891.7±10.50.830
48 h86.7±8.786.5±10.691.3±9.30.064
SpO2(%)
2 h97.4±1.897.4±1.897.3±2.20.845
4 h97.4±1.597.0±1.996.9±4.80.361
8 h97.2±1.697.3±1.697.6±2.00.458
16 h97.6±1.597.3±1.997.6±2.70.467
24 h97.8±1.597.5±1.697.4±3.60.469
48 h98.0±1.198.0±1.598.1±1.40.978
)], attaches=null, journal=Journal(id=1146441329971666965, delFlag=0, nameCn=解放军医学杂志, nameEn=Medical Journal of Chinese People’s Liberation Army, nameHistory1=null, nameHistory2=null, issn=0577-7402, eissn=null, cn=11-1056/R, coden=null, periodic=0, language=CN, oaType=是, ccby=CC BY-NC-ND, superviseOffice=null, ownerOffice=null, pubOffice=null, editorOffice=null, officeType=null, aims=null, clcCode=null, officeProv=null, officeCity=null, officeAddr=null, officeZip=null, officeEmail=null, officePhone=null, editDirector=null, officeDirector=null, officeDirectorPhone=null, officeStaffNum=null, officeEmpNum=null, coverPicUrl=6srot5PcoYX30Oa4xeTmeg==, journalPrice=null, startedYear=null, abbrevIsoEn=null, journalRemark=null, publicationField=null, createdTime=1751262512917, updatedTime=1761735725513, createdBy=18614031015, updatedBy=13701087609, firstLetterCn=M, firstLetterEn=M, subjectCode=Life Sciences, subjectName=Life Sciences, subjectCodeEn=Life Sciences, subjectNameEn=null, picCn=6srot5PcoYX30Oa4xeTmeg==, picEn=ELwBh5xqrSTlIs7HmSNt2Q==, jcr=null, cjcr=null, exts=[JournalExt(id=1190369167564968109, language=CN, name=解放军医学杂志, nameHistory1=null, nameHistory2=null, managedBy=, sponsoredBy=, publishedBy=, editorOffice=, officeProv=null, officeCity=null, officeAddr=, officeZip=, editDirector=, officeDirector=null, officePhone=null, coverPicUrl=null, journalRemark=, submitArticleUrl=null, websiteUrl=, createdTime=1761735725537, updatedTime=1761735725537, createdBy=13701087609, updatedBy=13701087609, submissionGuidelinesUrl=, submissionAuthorUrl=#, submissionEditorUrl=#, submissionReviewUrl=#, submissionCeEditorUrl=, submissionAeEditorUrl=, option={"copyright":""}), JournalExt(id=1190369167615299758, language=EN, name=Medical Journal of Chinese People’s Liberation Army, nameHistory1=null, nameHistory2=null, managedBy=, sponsoredBy=, publishedBy=, editorOffice=, officeProv=null, officeCity=null, officeAddr=, officeZip=, editDirector=, officeDirector=null, officePhone=null, coverPicUrl=null, journalRemark=, submitArticleUrl=null, websiteUrl=, createdTime=1761735725549, updatedTime=1761735725549, createdBy=13701087609, updatedBy=13701087609, submissionGuidelinesUrl=, submissionAuthorUrl=#, submissionEditorUrl=#, submissionReviewUrl=#, submissionCeEditorUrl=, submissionAeEditorUrl=, option={"copyright":""})], databaseList=null, tenantJournalId=1189873630562394117, websiteList=[Website(id=1189873845923287108, webName=null, webTitle=null, webDomain=null, webCopyrigh=null, webIpcNo=null, seoTitle=null, seoKeywords=null, seoDescription=null, tenantJournalId=null, journalId=1189873630562394117, journalNameCn=null, journalNameEn=null, grayFlag=null, tenantId=1146029695717560320, platformId=null, journalGroupId=null, journalGroupNameCn=null, journalGroupNameEn=null, type=1, domain=https://castjournals.cast.org.cn/joweb/jfjyxzz/CN, language=CN, createTime=1761617631655, createBy=18614031015, updateTime=1761622010471, updateBy=18614031015, name=解放军医学杂志-中文, tplId=1146099689490845704, title=解放军医学杂志, delFlag=0, indexPage=/home, props=[WebsiteProps(id=1189924939378520839, tenantId=1146029695717560320, journalId=null, journalGroupId=null, siteId=1189873845923287108, code=articleTextType, value=kx, createTime=1761629813284, updateTime=1761629813284, creator=18614031015, updator=18614031015), WebsiteProps(id=1189924939353355012, tenantId=1146029695717560320, journalId=null, journalGroupId=null, siteId=1189873845923287108, code=banner, value=null, createTime=1761629813278, updateTime=1761629813278, creator=18614031015, updator=18614031015), WebsiteProps(id=1189924939399492362, tenantId=1146029695717560320, journalId=null, journalGroupId=null, siteId=1189873845923287108, code=grayFlag, value=0, createTime=1761629813289, updateTime=1761629813289, creator=18614031015, updator=18614031015), WebsiteProps(id=1189924939344966403, tenantId=1146029695717560320, journalId=null, journalGroupId=null, siteId=1189873845923287108, code=logo, value=https://castjournals.cast.org.cn/joweb/jfjyxzz/CN/file/pic?fileId=+zXjYVhun8ZOAA6+aKx2hw==, createTime=1761629813276, updateTime=1761629813276, creator=18614031015, updator=18614031015), WebsiteProps(id=1189924939412075276, tenantId=1146029695717560320, journalId=null, journalGroupId=null, siteId=1189873845923287108, code=minRunFlag, value=0, createTime=1761629813292, updateTime=1761629813292, creator=18614031015, updator=18614031015), WebsiteProps(id=1189924939374326534, tenantId=1146029695717560320, journalId=null, journalGroupId=null, siteId=1189873845923287108, code=picServerUrl, value=https://castjournals.cast.org.cn/joweb/jfjyxzz/CN/file/pic, createTime=1761629813283, updateTime=1761629813283, creator=18614031015, updator=18614031015), WebsiteProps(id=1189924939407880971, tenantId=1146029695717560320, journalId=null, journalGroupId=null, siteId=1189873845923287108, code=silenceFlag, value=0, createTime=1761629813291, updateTime=1761629813291, creator=18614031015, updator=18614031015), WebsiteProps(id=1189924939361743621, tenantId=1146029695717560320, journalId=null, journalGroupId=null, siteId=1189873845923287108, code=staticResourcePath, value=https://castjournals.cast.org.cn/joweb/cast_kjdb_cn_619/, createTime=1761629813280, updateTime=1761629813280, creator=18614031015, updator=18614031015), WebsiteProps(id=1189924939386909448, tenantId=1146029695717560320, journalId=null, journalGroupId=null, siteId=1189873845923287108, code=themeColor, value=null, createTime=1761629813286, updateTime=1761629813286, creator=18614031015, updator=18614031015), WebsiteProps(id=1189924939395298057, tenantId=1146029695717560320, journalId=null, journalGroupId=null, siteId=1189873845923287108, code=themeStyle, value=null, createTime=1761629813288, updateTime=1761629813288, creator=18614031015, updator=18614031015)]), Website(id=1189873846057504839, webName=null, webTitle=null, webDomain=null, webCopyrigh=null, webIpcNo=null, seoTitle=null, seoKeywords=null, seoDescription=null, tenantJournalId=null, journalId=1189873630562394117, journalNameCn=null, journalNameEn=null, grayFlag=null, tenantId=1146029695717560320, platformId=null, journalGroupId=null, journalGroupNameCn=null, journalGroupNameEn=null, type=1, domain=https://castjournals.cast.org.cn/joweb/jfjyxzz/EN, language=EN, createTime=1761617631687, createBy=18614031015, updateTime=1761622030030, updateBy=18614031015, name=解放军医学杂志-英文, tplId=1146101810881728533, title=Medical Journal of Chinese People’s Liberation Army, delFlag=0, indexPage=/home, props=[WebsiteProps(id=1189924968168223505, tenantId=1146029695717560320, journalId=null, journalGroupId=null, siteId=1189873846057504839, code=articleTextType, value=kx, createTime=1761629820148, updateTime=1761629820148, creator=18614031015, updator=18614031015), WebsiteProps(id=1189924968147251982, tenantId=1146029695717560320, journalId=null, journalGroupId=null, siteId=1189873846057504839, code=banner, value=null, createTime=1761629820143, updateTime=1761629820143, creator=18614031015, updator=18614031015), WebsiteProps(id=1189924968185000724, tenantId=1146029695717560320, journalId=null, journalGroupId=null, siteId=1189873846057504839, code=grayFlag, value=0, createTime=1761629820152, updateTime=1761629820152, creator=18614031015, updator=18614031015), WebsiteProps(id=1189924968138863373, tenantId=1146029695717560320, journalId=null, journalGroupId=null, siteId=1189873846057504839, code=logo, value=https://castjournals.cast.org.cn/joweb/jfjyxzz/EN/file/pic?fileId=+zXjYVhun8ZOAA6+aKx2hw==, createTime=1761629820141, updateTime=1761629820141, creator=18614031015, updator=18614031015), WebsiteProps(id=1189924968197583638, tenantId=1146029695717560320, journalId=null, journalGroupId=null, siteId=1189873846057504839, code=minRunFlag, value=0, createTime=1761629820155, updateTime=1761629820155, creator=18614031015, updator=18614031015), WebsiteProps(id=1189924968159834896, tenantId=1146029695717560320, journalId=null, journalGroupId=null, siteId=1189873846057504839, code=picServerUrl, value=https://castjournals.cast.org.cn/joweb/jfjyxzz/EN/file/pic, createTime=1761629820146, updateTime=1761629820146, creator=18614031015, updator=18614031015), WebsiteProps(id=1189924968193389333, tenantId=1146029695717560320, journalId=null, journalGroupId=null, siteId=1189873846057504839, code=silenceFlag, value=0, createTime=1761629820154, updateTime=1761629820154, creator=18614031015, updator=18614031015), WebsiteProps(id=1189924968155640591, tenantId=1146029695717560320, journalId=null, journalGroupId=null, siteId=1189873846057504839, code=staticResourcePath, value=https://castjournals.cast.org.cn/joweb/cast_kjdb_en_623/, createTime=1761629820145, updateTime=1761629820145, creator=18614031015, updator=18614031015), WebsiteProps(id=1189924968172417810, tenantId=1146029695717560320, journalId=null, journalGroupId=null, siteId=1189873846057504839, code=themeColor, value=null, createTime=1761629820149, updateTime=1761629820149, creator=18614031015, updator=18614031015), WebsiteProps(id=1189924968180806419, tenantId=1146029695717560320, journalId=null, journalGroupId=null, siteId=1189873846057504839, code=themeStyle, value=null, createTime=1761629820151, updateTime=1761629820151, creator=18614031015, updator=18614031015)])], journalTitle=解放军医学杂志, weixinUrl=null, journalUrl=http://zh.jfjyxzz.org.cn/, iacademicId=null, status=1, seqNo=null, journalTitleEn=Medical Journal of Chinese People’s Liberation Army, journalPhotoCn=6srot5PcoYX30Oa4xeTmeg==, journalPhotoEn=ELwBh5xqrSTlIs7HmSNt2Q==, journalFirstLetter=M, journalRecommend=null, journalNew=null, journalCollection=null, jcrJf=null, cjcrJf=null, jcrJfStr=null, cjcrJfStr=null, submissionFirstDecision=null, sciSubjectClassification=null, casSubjectClassification=null, citeScore=null, totalCitationFrequency=null, icpCode=null, psCode=null, advertisingLicenseCode=null, copyrightInformation=null, country=null, option=, provinceCode=null, provinceName=null, collectFlag=false), detailUrlCn=https://castjournals.cast.org.cn/joweb/jfjyxzz/CN/10.11855/j.issn.0577-7402.0337.2023.0718, detailUrlEn=https://castjournals.cast.org.cn/joweb/jfjyxzz/EN/10.11855/j.issn.0577-7402.0337.2023.0718, pdfUrlCn=https://castjournals.cast.org.cn/joweb/jfjyxzz/CN/PDF/10.11855/j.issn.0577-7402.0337.2023.0718, pdfUrlEn=https://castjournals.cast.org.cn/joweb/jfjyxzz/EN/PDF/10.11855/j.issn.0577-7402.0337.2023.0718, aliStartDate=null, aliEndDate=null, collectionFlag=false, citedCount=null, citedUrl=null, reference=null)
收藏切换
零阿片术后自控镇痛策略在胸科腔镜手术中的应用效果
收藏切换
PDF下载
李汶谦 , 李晓霞 *
解放军医学杂志 | 临床研究 2024,49(6): 656-662
收起
收藏切换
解放军医学杂志 | 临床研究 2024, 49(6): 656-662
零阿片术后自控镇痛策略在胸科腔镜手术中的应用效果
全屏
李汶谦, 李晓霞*
作者信息
  • 重庆医科大学附属第二医院麻醉科，重庆 400010

    • 李汶谦，硕士研究生，主要从事零阿片麻醉策略、围手术期镇痛等方面的研究

通讯作者:

李晓霞，E-mail：
Application effect of opioid-free postoperative patient-controlled analgesia strategy in thoracic endoscopic surgery
Wen-Qian Li, Xiao-Xia Li*
Affiliations
  • Department of Anesthesiology, the Second Affiliated Hospital of Chongqing Medical University, Chongqing 400010, China
出版时间: 2024-06-28 doi: 10.11855/j.issn.0577-7402.0337.2023.0718
文章导航
收藏切换
摘要
收起

目的 探讨零阿片术后自控镇痛策略在胸科腔镜肺部病损切除术中的应用效果。方法 本研究为单中心、双盲前瞻性、开放性、随机对照试验。纳入2021年11月-2023年4月重庆医科大学附属第二医院在胸科腔镜下行肺部病损切除术的患者90例，依据随机数字表法分为艾司氯胺酮+右美托咪定(esKDex)组(n=30)、舒芬太尼+右美托咪定(sFDex)组(n=30)、曲马多+右美托咪定(TraDex)组(n=30)。比较3组术后48 h内恶心呕吐(PONV)的发生率、生命体征相关指标、视觉模拟评分法(VAS)评分、BCS舒适评分、Ramsay镇静评分、简易精神状态(MMSE)评分。结果 术后48 h内，esKDex组PONV发生率低于sFDex组及TraDex组，差异有统计学意义[10.0%(3/30) vs. 20.0%(6/30) vs. 20.0%(6/30)，P<0.001]。esKDex组及sFDex组术后2、4 h的VAS评分均低于TraDex组(术后2 h：P=0.001、0.001；术后4 h：P=0.027、0.024)，术后24、48 h的VAS评分均高于TraDex组(术后24 h：P=0.008、0.029；术后48 h：P=0.005、0.005)。esKDex组和sFDex组术后24、48 h的BCS舒适评分均低于TraDex组(术后24 h：P=0.017、0.007；术后48 h：P=0.005、0.007)。3组术后48 h内的Ramsay镇静评分、MMSE评分差异均无统计学意义(P>0.05)。结论 艾司氯胺酮联合右美托咪定的零阿片术后自控镇痛策略在满足胸科腔镜肺部病损切除术术后患者镇静镇痛前提下能降低PONV发生率。

胸外科手术  /  术后镇痛  /  多模式镇痛  /  零阿片类麻醉策略

Objective To explore the application effect of opioid-free postoperative patient-controlled analgesia strategy in thoracic endoscopic resection of lung lesions. Methods This study is a single center, double-blind, prospective, open label, randomized controlled trial. Ninety patients with lung surgery under thoracic endoscope in the Second Affiliated Hospital of Chongqing Medical University were selected from November 2021 to April 2023, and divided into three groups, according to the random number table method including esketamine and dexmedetomidine (esKDex group, n=30), sufentanil and dexmedetomidine (sFDex group, n=30) and tramadol and dexmedetomidine (TraDex group, n=30). The incidence of postoperative nausea and vomiting (PONV), vital signs related indicators, visual analogue scale (VAS) score, Ramsay sedation (RSS) score, Bruggrmann comfort scale (BCS) score and mini-mental state examination (MMSE) score were compared among the 3 groups within 48 hours after surgery. Results Within 48 h after surgery, the incidence of PONV in esKDex group was lower than that in sFDex group and TraDex group [10.0%(3/30) vs. 20.0%(6/30) vs. 20.0%(6/30), P<0.001]. The VAS scores in esKDex group and sFDex group at 2 h and 4 h after surgery were lower than those in TraDex group (2 h after surgery: P=0.001, 0.001; 4 h after surgery: P=0.027, 0.024). The VAS scores at 24 h and 48 h after surgery were higher than those in TraDex group (24 h after surgery: P=0.008, 0.029; 48 h after surgery: P=0.005, 0.005). The BCS scores of esKDex group and sFDex group at 24 h and 48 h after surgery were lower than those in TraDex group (24 h after surgery: P=0.017, 0.007; 48 h after surgery: P=0.005, 0.007). There was no significant difference between Ramsay scores and MMSE scores among the three groups within 48 h after surgery (P>0.05). Conclusion The strategy of opioid-free postoperative patient-controlled analgesia (esketamine and dexmedetomidine) can reduce the incidence of PONV under the premise of satisfying the sedation and analgesia of patients after thoracic endoscopic surgery.

thoracic surgery  /  postoperative analgesia  /  multimodal analgesia  /  opioid-free analgesia strategy
李汶谦, 李晓霞. 零阿片术后自控镇痛策略在胸科腔镜手术中的应用效果. 解放军医学杂志, 2024 , 49 (6) : 656 -662 . DOI: 10.11855/j.issn.0577-7402.0337.2023.0718
Wen-Qian Li, Xiao-Xia Li. Application effect of opioid-free postoperative patient-controlled analgesia strategy in thoracic endoscopic surgery[J]. Medical Journal of Chinese People’s Liberation Army, 2024 , 49 (6) : 656 -662 . DOI: 10.11855/j.issn.0577-7402.0337.2023.0718
正文
收起
腔镜手术是胸科常见的手术类型，胸科手术术后疼痛被认为是术后最严重的疼痛之一。皮肤切口、肋间神经损伤、肋骨牵拉及骨折、肺实质及胸膜刺激、引流管的放置等创伤性事件均可引发交感兴奋和炎症反应，从而加重患者术后疼痛[1]。腔镜微创是外科手术的发展趋势，电视胸腔镜手术(video-assisted thoracoscopic surgery，VATS)是胸外科手术微创化的重要实现途径，具有创伤小、出血少、疼痛轻、手术时间短、恢复快、住院时间短等优点[2]。尽管VATS侵袭性较小，但术后中至重度疼痛仍很常见[3]。因此，胸科手术术后镇痛的实施及镇痛效果越来越受到重视。术后镇痛对于促进患者术后尽早恢复、降低术后并发症发生率十分重要[4]。传统的镇痛配方以阿片类(如舒芬太尼)药物为主，使用阿片类药物是术后恶心呕吐(postoperative nausea and vomiting，PONV)的主要危险因素[5]。因此亟须寻找一种新的胸科手术术后镇痛配方以减少患者发生PONV，提高术后舒适程度。而艾司氯胺酮(esketamine)的出现为这种配方提供了可能，其是氯胺酮的右旋异构体，二者均通过作用于N-甲基-D-天冬氨酸(NMDA)受体发挥麻醉与镇痛作用，但艾司氯胺酮与NMDA受体的亲和力是氯胺酮的2倍，且生物利用度较高、代谢较快，因此镇痛作用更显著且不良反应少[6-7]。右美托咪定是一种新型高选择性的α2肾上腺素能受体激动剂，具有抗焦虑、镇静、镇痛和阻滞交感神经的作用，在减轻应激反应的同时，无抑制呼吸作用[8-9]。本研究观察艾司氯胺酮联合右美托咪定在胸科腔镜肺部病损切除术术后静脉自控镇痛(PCIA)中的可行性、镇痛效果及PONV发生率，优化镇痛方案，以降低术后PONV发生率。
1 资料与方法
收起
1.1 研究对象
本研究为单中心、双盲、前瞻性、开放性、随机对照试验。纳入2021年11月-2023年4月重庆医科大学附属第二医院在胸科腔镜下行肺部病损切除手术的患者90例。纳入标准：(1)美国麻醉医师协会(American Society of Anesthesiologists，ASA)分级Ⅰ-Ⅲ级；(2)年龄19~65岁；(3)能够熟练应用自控镇痛泵(patient-controlled analgesia，PCA)；(4)理解并充分配合使用术后各项评分工具。排除标准：(1)体重指数(body mass index，BMI)>30 kg/m²；(2)近6个月内出现心绞痛或心肌梗死病史；(3)控制不佳或未经治疗的高血压(静息收缩压/舒张压>180/100 mmHg)；(4)未经治疗或治疗不足的甲亢；(5)肝、肾功能不全；(6)神经精神疾病；(7)长期酗酒；(8)长期使用镇静催眠镇痛药物；(9)心率(heart rate，HR)<50次/min或有Ⅲ度房室传导阻滞；(10)已知对试验药物如右美托咪定和(或)艾司氯胺酮过敏；(11)术中更改手术方式；(12)围手术期资料丢失。退出标准：发生严重不良事件。依据随机数字表法将患者均分为esKDex组(艾司氯胺酮+右美托咪啶)、sFDex组(舒芬太尼+右美托咪啶)与TraDex组(曲马多+右美托咪啶)(n=30)。本研究获重庆医科大学附属第二医院伦理委员会审批[2022年科伦审第(9)号]，并在中国临床试验中心注册(注册号：ChiCTR2200056551)，患者均签署知情同意书。
1.2 治疗方法
患者术前常规禁食8 h、禁饮2 h，均无术前用药。入室后开放外周静脉通道，常规监测HR、平均动脉压(mean arterial pressure，MAP)、心电图(electrocardiogram，ECG)、呼吸频率(respiratory rate，RR)、脉搏血氧饱和度(oxygen saturation，SpO2)、呼气末二氧化碳分压(partial pressure of end-tidal carbon dioxide，PetCO2)。
1.2.1 麻醉诱导与维持
由主管麻醉医师选择麻醉诱导药物[包括咪达唑仑(0.02~0.15 mg/kg)、丙泊酚(1~2 mg/kg)、舒芬太尼(0.1~1.0 μg/kg)、罗库溴铵(0.6 mg/kg)]。麻醉诱导完毕后，依据术前CT结果选择合适的双腔气管导管置入，机械通气，潮气量8~10 ml/kg，RR 12~14次/min，PetCO2维持在35~40 mmHg。以七氟烷、丙泊酚、瑞芬太尼及罗库溴铵维持麻醉深度，并根据血压和HR调整用量，以维持血流动力学的稳定。术中采用脑电双频指数(bispectral index，BIS)监测麻醉深度，维持BIS在35~55。手术结束前0.5 h静脉给予患者镇痛泵负荷量，手术结束停止静脉泵注的维持用药，并连接镇痛泵。由主管麻醉医师决定拔管时间以及患者是否返回病房。
1.2.2 镇痛泵配方
(1)esKDex组：艾司氯胺酮1 mg/kg+右美托咪定2 μg/kg+托烷司琼6 mg配制成100 ml溶液。手术结束前30 min在镇痛泵液体中抽取5 ml以艾司氯胺酮0.05 mg/kg+右美托咪定0.1 μg/kg+托烷司琼0.3 mg为负荷剂量缓慢静脉推注。(2)sFDex组：舒芬太尼2 μg/kg+右美托咪定2 μg/kg+托烷司琼6 mg配制成100 ml溶液。手术结束前30 min在镇痛泵液体中抽取5 ml以舒芬太尼0.1 μg/kg+右美托咪定0.1 μg/kg+托烷司琼0.3 mg为负荷剂量缓慢静脉推注。(3)TraDex组：曲马多800 mg+右美托咪定2 μg/kg+托烷司琼6 mg配制成100 ml溶液。手术结束前30 min在镇痛泵液体中抽取5 ml以曲马多40 mg+右美托咪定0.1 μg/kg+托烷司琼0.3 mg为负荷剂量缓慢静脉推注。
3组背景剂量2 ml/h，按压1 ml/次，锁定时间15 min。对于术后48 h内视觉模拟评分法(visual analogue scale，VAS)评分>4分的患者，给予100 mg曲马多静脉注射进行抢救性镇痛治疗。对于术后48 h发生PONV的患者，给予甲氧氯普胺10 mg静脉注射进行镇吐治疗，并停用镇痛泵，至术后48 h观察结束不再继续使用镇痛泵。
1.3 观察指标
(1)收集患者的年龄、性别、身高、体重、疾病病种、手术方式、ASA分级等一般资料。(2)采用Apfel风险系统评估PONV的发生风险。Apfel风险评估采用4个风险因素：女性、非吸烟状态、既往PONV历史、术后阿片类药物的使用。各风险因素均权重相同，患者每多一个风险因素，PONV的发生率增高约20%。(3)记录3组患者术中阿片类药物(舒芬太尼和瑞芬太尼)用量。(4)记录患者入手术室(T1)、麻醉开始(T2)、手术开始(T3)、手术结束(T4)、出手术室(T5) 5个时间点的MAP、HR及SpO2。(5)手术结束后48 h进行随访，询问患者一般情况，每天对患者进行评估并记录使用镇痛泵的相关不良反应，如呼吸抑制(RR<8次/min或SpO2<90%)、低血压(收缩压<80 mmHg或血压降低超过基础血压的30%)、恶心、呕吐、尿潴留、皮肤瘙痒等的发生次数。患者术后若出现PONV，则记录出现的时间、次数，并停用镇痛泵，给予甲氧氯普胺10 mg静脉注射后观察患者情况是否好转。(6)记录镇痛泵开始后2、4、8、16、24、48 h患者的VAS评分、Ramsay镇静评分、BCS舒适评分、简易精神状态(mini-mental state examination，MMSE)评分以及生命体征(包括MAP、HR、RR及SpO2)的变化。
1.4 评分方法
1.4.1 VAS评分
使用一条10 cm长的标尺进行评估，标尺刻有10个刻度，其两端分别为“0”分端和“10”分端，无痛为0分，剧痛难以忍受为10分。临床评定以0~2分为优，3~5分为良，6~8分为可，>8分为差。
1.4.2 BCS舒适评分
持续疼痛为0分；安静时无痛，深呼吸或咳嗽时疼痛严重为1分；安静时无痛，深呼吸或咳嗽时轻微疼痛为2分；深呼吸时也无痛为3分；咳嗽时也无痛为4分。
1.4.3 Ramsay镇静评分
患者焦虑、不安或烦躁为1分；患者合作、定向力良好或安静为2分；患者仅对命令有反应为3分；患者对轻叩眉间或强声刺激反应敏捷为4分；患者对轻叩眉间或者强声刺激反应迟钝为5分；患者对轻叩眉间或者强声刺激无任何反应为6分。
1.4.4 MMSE评分
(1)认知功能障碍。最高得分为30分，评分为27~30分为正常，<27分为认知功能障碍。(2)痴呆划分标准。文盲≤17分，小学程度≤20分，中学程度(包括中专)≤22分，大学程度(包括大专)≤23分。(3)痴呆严重程度分级。轻度为MMSE评分≥21分；中度为MMSE评分10~20分；重度为MMSE评分≤9分。
1.5 统计学处理
采用SPSS 22软件进行统计分析。符合正态分布的计量资料以$\bar{x}±s$表示，多组间比较采用方差分析，进一步两两比较采用LSD-t法。计数资料以率(%)表示，多组间比较采用χ2检验，进一步两两比较则在χ2检验的基础上进行Bonferroni校正。
P<0.05为差异有统计学意义。
2 结果
收起
2.1 一般资料比较
3组年龄、性别、疾病病种、手术方式、ASA分级、BMI比较差异均无统计学意义(P>0.05，表1)。
2.2 3组术中生命体征及阿片类药物使用量比较
3组术中阿片类药物(舒芬太尼、瑞芬太尼)使用量，以及T1-T5的MAP、HR、SpO2比较差异均无统计学意义(P>0.05，表2)。
2.3 3组Apfel风险评分比较
esKDex组Apfel风险评分低于sFDex组和TraDex组，差异有统计学意义(P<0.001)。在其他高危因素中，esKDex组中有既往PONV历史的患者比例高于sFDex组和TraDex组，差异有统计学意义[13.3%(4/30) vs. 3.3%(1/30) vs. 3.3%(1/30)，P<0.001]；sFDex组和TraDex组术后镇痛泵配方均含有阿片类药物，esKDex组术后镇痛泵配方不含阿片类药物，3组术后阿片类药物使用情况比较，差异有统计学意义(P<0.001)(表3)。
2.4 3组PONV发生情况比较
术后48 h内，esKDex组PONV发生率低于sFDex组和TraDex组，差异有统计学意义[10.0%(3/30) vs. 20.0%(6/30) vs. 20.0%(6/30)，P<0.001]。
3组术后PONV发生情况如表4所示。esKDex组中，1例术后4~8 h发生1次PONV，1例术后8~16 h发生1次PONV，1例术后16~24 h发生1次PONV，均停用镇痛泵并给予甲氧氯普胺10 mg静脉注射后情况好转。sFDex组中，1例手术结束至术后2 h发生1次PONV，3例术后8~16 h发生1次PONV，2例术后16~24 h发生1次PONV，均停用镇痛泵并给予胃复安10 mg静脉注射后情况好转。TraDex组中，1例手术结束至术后2 h发生1次PONV，2例术后4~8 h发生1次PONV，3例术后8~16 h发生1次PONV，均停用镇痛泵并给予胃复安10 mg静脉注射后情况好转。
2.5 3组术后48 h内VAS评分、BCS舒适评分、Ramsay镇静评分及MMSE评分比较
esKDex组和sFDex组术后2、4 h的VAS评分均低于TraDex组(术后2 h：P=0.001、0.001；术后4 h：P=0.027、0.024)，术后24、48 h的VAS评分均高于TraDex组(术后24 h：P=0.008、0.029；术后48 h：P=0.005、0.005)。
esKDex组和sFDex组术后24、48 h的BCS舒适评分均低于TraDex组(术后24 h：P=0.017、0.007；术后48 h：P=0.005、0.007)。
3组术后48 h内Ramsay镇静评分、MMSE评分差异无统计学意义(P>0.05，表5)。
2.6 3组术后48 h内VAS评分>4分的患者情况比较
esKDex组、sFDex组、TraDex组术后48 h内VAS评分>4分的患者占比差异有统计学意义[6.6%(2/30) vs. 6.6%(2/30) vs. 0%(0/30)，P<0.001]。术后48 h内esKDex组和sFDex组各有2例VAS评分>4分，其中esKDex组2例术后24~48 h VAS评分>4分，sFDex组2例术后16~24 h VAS评分>4分，在病房给予100 mg曲马多静脉注射进行抢救性镇痛治疗后疼痛均缓解，再次进行VAS疼痛评分测量评分均<4分。3组均无呼吸抑制、低血压、尿潴留、皮肤瘙痒等术后不良反应。
2.7 3组术后生命体征比较
esKDex组和sFDex组术后2 h的MAP低于TraDex组，差异有统计学意义(P=0.005、0.039)；术后48 h的RR低于TraDex组，差异有统计学意义(P=0.005、0.014)。3组术后2、4、8、16、24、48 h的HR、SpO2差异均无统计学意义(P>0.05)(表6)。
3 讨论
收起
VATS经过不断发展，已成为治疗肺部疾病的主要方法[10]。不同病种的手术方式不同，患者的疼痛情况也有所差异。本研究选取重庆医科大学附属第二医院在电视胸腔镜下行肺部病损切除术的患者90例，在病种方面，选择肺大疱和肺结节两种常见的肺部疾病病种，在手术方式方面，选择肺楔形切除术和肺段切除术两种术式，3组疾病病种与手术方式差异均无统计学意义。
本研究主要观察指标为术后48 h PONV发生率。目前最常用的PONV风险分层工具为Apfel风险评分[11-12]。esKDex组中有既往PONV历史的患者比例高于sFDex组和TraDex组，但术后48 h内esKDex组PONV发生率低于sFDex组和TraDex组，一定程度上体现了艾司氯胺酮联合右美托咪定的零阿片术后自控镇痛策略在降低PONV高危险因素患者术后PONV发生率方面的优越性。
国际疼痛研究协会(IASP)对疼痛的定义是“一种与实际或潜在的组织损伤相关的不愉快的感官和情感体验”[13]，VAS量表是使用最广泛的评估疼痛严重程度和判断疼痛缓解程度的工具[14-16]。部分研究表明，曲马多的代谢物O-去甲基曲马多代谢物(M1)也具有作为弱μ阿片受体(MOR)激动剂的镇痛作用[17]。健康成人给药后，曲马多及其代谢物M1在2~3 h到达血浆。曲马多的M1代谢物较曲马多的效力强，亲和力高200倍。曲马多和M1代谢物的血浆半衰期分别为6.3 h和7.4 h[18]。而舒芬太尼并无活性代谢物[19]。本研究结果显示，esKDex组和sFDex组术后2、4 h的VAS评分均低于TraDex组，术后24、48 h的VAS评分均高于TraDex组。虽然3组患者术后6个时间点的VAS评分有所差异，但平均值差异为0~2分，VAS评分<4分，均满足患者术后镇痛的需求。
胸外科手术术后疼痛一度被认为是术后最严重的疼痛之一，术后中至重度疼痛仍然常见[20]。术后48 h患者需要咳嗽排痰、及时下床活动来减少如长时间制动、不能清除支气管分泌物导致的气道闭合、肺不张、分流和低氧血症等术后并发症。在咳嗽排痰和下床活动的过程中均会导致疼痛加剧。本研究结果显示，esKDex组和sFDex组术后24、48 h的BCS舒适评分均低于TraDex组；3组BCS舒适评分差异均在2~3分范围内，表明疼痛不影响患者睡眠。
3组Ramsay镇静评分无明显差异。作为一种高选择性的α2肾上腺素能受体激动剂，右美托咪定作用于皮层下系统，可产生镇静作用，提高术后睡眠质量[21-23]。右美托咪定可提供无呼吸障碍的镇静作用，在Ramsay镇静评分标准中，2分为患者合作、定向力良好或安静，分数越高，患者对外界刺激的反应越弱，镇静深度越深，3组患者术后48 h内Ramsay镇静评分均<3分，并未提示有不必要的镇静作用出现。
艾司氯胺酮可与脊髓、大脑中的NMDA受体结合，通过阻断钙离子内流来降低钙离子通道的开放[24]，非竞争性抑制谷氨酸对NMDA受体的激活，减弱神经元活动来产生镇痛效果。艾司氯胺酮应用于围手术期镇痛，可能引起解离症状等精神病样不良反应[25]，这些不良反应的发生均呈剂量依赖性。尽管90例患者在术后48 h内均无神经系统不良反应发生，且3组MMSE评分无明显差异，但在术后8、24、48 h这3个时间点，esKDex组MMSE评分较sFDex组和TraDex组低。目前仍缺乏多中心、大样本的相关临床研究支持艾司氯胺酮不良反应的发生情况，仍需进一步探究和验证。
esKDex组和sFDex组术后2 h的MAP低于TraDex组，术后48 h的RR低于TraDex组。3组患者术后48 h内的MAP、RR差异均在该生命体征的正常值范围内，生命体征平稳。
疼痛是五大生命体征之一。随着医学的不断进步，胸外科手术术后有许多镇痛方案可供麻醉医师选择[26]，多模式镇痛是当下热门的研究方向，减少阿片类药物的使用以及阿片类药物所引起的不良反应很好地契合了多模式镇痛的理念。零阿片类麻醉策略(opioid-free anaesthesia，OFA)是近年来在多模式镇痛的基础上逐渐发展形成的一种围手术期镇痛策略[27-28]。OFA最确切的定义为在围手术期最大程度地增加非阿片类药物和措施的使用，但同时保留使用阿片类药物的机会。本研究在胸科腔镜手术术后使用艾司氯胺酮复合右美托咪定的零阿片自控镇痛策略，相较其他添加阿片类药物的右美托咪定+曲马多组和右美托咪定+舒芬太尼组，其PONV发生率有所降低，同时不增加术后其他不良反应的发生，不影响患者术后的生命体征。
本研究仍存在一定的局限性。首先，采用的术后镇静镇痛评分(VAS评分、BCS舒适评分、Ramsay镇静评分、MMSE评分)方法主观性较大。其次，由于时间的限制，样本量较小，未来可进行大样本量的多中心研究，覆盖更广泛的人群，尽可能降低主观评分所带来的偏差，提高数据的可信度和准确性，使研究结果更具代表性。
综上所述，艾司氯胺酮联合右美托咪定的零阿片术后自控镇痛策略在满足胸科腔镜手术术后患者的镇痛前提下能降低PONV发生率，同时不增加术后其他不良反应的发生，不影响患者术后的生命体征。
文献
收起
参考文献 引证文献
排序方式：
[1]
陈秀科, 李东涛, 张福维, 等. 剑突入路胸腔镜手术对前纵隔肿瘤患者应激指标及血清肿瘤标志物影响[J]. 临床军医杂志, 2023, 51(4): 397-400.
[2]
丁凯. 肺部小结节手术定位研究进展[J]. 新乡医学院学报, 2023, 40(12): 1195-1200.
[3]
Bayman EO, Parekh KR, Keech J, et al. Preoperative patient expectations of postoperative pain are associated with moderate to severe acute pain after VATS[J]. Pain Med, 2019, 20(3): 543-554.
[4]
陈小红, 李萌萌, 黄璜, 等. 右美托咪定对胸外科患者围手术期焦虑的影响[J]. 解放军医学杂志, 2022, 47(5): 464-470.
[5]
Panwar R, Pal S. The International Study Group of Pancreatic Surgery definition of delayed gastric emptying and the effects of various surgical modifications on the occurrence of delayed gastric emptying after pancreatoduodenectomy[J]. Hepatobiliary Pancreat Dis Int, 2017, 16(4): 353-363.
[6]
Trimmel H, Helbok R, Staudinger T, et al. S(+)-ketamine: current trends in emergency and intensive care medicine[J]. Wien Klin Wochenschr, 2018, 130(9-10): 356-366.
[7]
牛莉, 韩焕芝, 孙静静, 等. 无痛分娩中应用不同剂量艾司氯胺酮效果及对产后抑郁影响[J]. 临床军医杂志, 2023, 51(4): 424-426.
[8]
Ebert TJ, Hall JE, Barney JA, et al. The effects of increasing plasma concentrations of dexmedetomidine in humans[J]. Anesthesiology, 2000, 93(2): 382-394.
[9]
丁允莹, 嵇富海, 彭科. 右美托咪定的器官保护作用及其机制概述[J]. 解放军医学杂志, 2023, 48(11): 1267-1275.
[10]
Haynes D, Baumann MH. Management of pneumothorax[J]. Semin Respir Crit Care Med, 2010, 31(6): 769-780.
[11]
Darvall J, Handscombe M, Maat B, et al. Interpretation of the four risk factors for postoperative nausea and vomiting in the Apfel simplified risk score: an analysis of published studies[J]. Can J Anaesth, 2021, 68(7): 1057-1063.
[12]
Klenke S, de Vries GJ, Schiefer L, et al. Genetic contribution to PONV risk[J]. Anaesth Crit Care Pain Med, 2020, 39(1): 45-51.
[13]
Li SF, Greenwald PW, Gennis P, et al. Effect of age on acute pain perception of a standardized stimulus in the emergency department[J]. Ann Emerg Med, 2001, 38(6): 644-647.
[14]
Jensen MP, Karoly P, Braver S. The measurement of clinical pain intensity: a comparison of six methods[J]. Pain, 1986, 27(1): 117-126.
[15]
Hawker GA, Mian S, Kendzerska T, et al. Measures of adult pain: visual analog scale for pain (VAS pain), numeric rating scale for pain (NRS pain), McGill pain questionnaire (MPQ), short-form McGill pain questionnaire (SF-MPQ), chronic pain grade scale (CPGS), short form-36 bodily pain scale (SF-36 BPS), and measure of intermittent and constant osteoarthritis pain (ICOAP)[J]. Arthritis Care Res (Hoboken), 2011, 63(): S240-S252.
[16]
Karcioglu O, Topacoglu H, Dikme O, et al. A systematic review of the pain scales in adults: which to use?[J]. Am J Emerg Med, 2018, 36(4): 707-714.
[17]
Subedi M, Bajaj S, Kumar MS, et al. An overview of tramadol and its usage in pain management and future perspective[J]. Biomed Pharmacother, 2019, 111: 443-451.
[18]
Black PA, Cox SK, Macek M, et al. Pharmacokinetics of tramadol hydrochloride and its metabolite O-desmethyltramadol in peafowl (Pavo cristatus)[J]. J Zoo Wildl Med, 2010, 41(4): 671-676.
[19]
Oh SK, Lee IO, Lim BG, et al. Comparison of the analgesic effect of sufentanil versus fentanyl in intravenous patient-controlled analgesia after total laparoscopic hysterectomy: a randomized, double-blind, prospective study[J]. Int J Med Sci, 2019, 16(11): 1439-1446.
[20]
Bayman EO, Parekh KR, Keech J, et al. A prospective study of chronic pain after thoracic surgery[J]. Anesthesiology, 2017, 126(5): 938-951.
[21]
Chen Z, Tang R, Zhang R, et al. Effects of dexmedetomidine administered for postoperative analgesia on sleep quality in patients undergoing abdominal hysterectomy[J]. J Clin Anesth, 2017, 36: 118-122.
[22]
Nelson LE, Lu J, Guo T, et al. The alpha2-adrenoceptor agonist dexmedetomidine converges on an endogenous sleep-promoting pathway to exert its sedative effects[J]. Anesthesiology, 2003, 98(2): 428-436.
[23]
Hall JE, Uhrich TD, Barney JA, et al. Sedative, amnestic, and analgesic properties of small-dose dexmedetomidine infusions[J]. Anesth Analg, 2000, 90(3): 699-705.
[24]
Peltoniemi MA, Hagelberg NM, Olkkola KT, et al. Ketamine: a review of clinical pharmacokinetics and pharmacodynamics in anesthesia and pain therapy[J]. Clin Pharmacokinet, 2016, 55(9): 1059-1077.
[25]
Jelen LA, Young AH, Stone JM. Ketamine: A tale of two enantiomers[J]. J Psychopharmacol, 2021, 35(2): 109-123.
[26]
李汶谦, 李晓霞. 胸外科手术术后镇痛研究进展[J]. 现代医药卫生, 2022, 38(17): 2968-2978.
[27]
Harkouk H, Fletcher D, Beloeil H. Opioid free anaesthesia: myth or reality?[J]. Anaesth Crit Care Pain Med, 2019, 38(2): 111-112.
[28]
Mulier J, Dekock M. Opioid free general anesthesia, a new paradigm?[J]. Best Pract Res Clin Anaesthesiol, 2017, 31(4): 441-443.
2024年第49卷第6期
PDF下载
205
95
引用本文
BibTeX
文章信息
doi: 10.11855/j.issn.0577-7402.0337.2023.0718
  • 接收时间：2023-03-03
  • 首发时间：2025-11-21
  • 出版时间：2024-06-28
补充材料
相关文章
文章信息
作者
出版历史
  • 收稿日期：2023-03-03
  • 录用日期：2023-05-30
基金
作者信息
    重庆医科大学附属第二医院麻醉科，重庆 400010

通讯作者:

李晓霞，E-mail：
参考文献
分享链接
https://castjournals.cast.org.cn/joweb/jfjyxzz/CN/10.11855/j.issn.0577-7402.0337.2023.0718
分享至
全文二维码

扫描看全文

引用本文
BibTeX
本文的引用情况
2种不同金属材料的力学参数
科
Family		 属数
Number of
genus		 种数
Number of
species		 占总种数比例
Percentage of
total species (%)		 属
Genus		 种数
Number of
species		 占总种数比例
Percentage of total
species (%)
鹅膏菌科Amanitaceae 2 11 5.26 鹅膏菌属 Amanita 10 4.78
小菇科 Mycenaceae 2 12 5.74 丝盖伞属 Inocybe 5 2.39
多孔菌科 Polyporaceae 8 14 6.70 蜡蘑属 Laccaria 5 2.39
红菇科 Russulaceae 3 23 11.00 小皮伞属 Marasmius 6 2.87
小菇属 Mycena 11 5.26
光柄菇属 Pluteus 5 2.39
红菇属 Russula 17 8.13
栓菌属 Trametes 5 2.39
关闭全屏
相关链接
论文
最新文章
热读文章
热点专题
内参
蓝皮书
产业发展报告
传播力报告
期刊分级目录
资讯
学术新闻
行业新闻
学术会议
行业会议
关于
关于我们
联系我们
北京市海淀区学院南路86号
100081
010-62199257
qkjq@cast.org.cn

中国科学技术协会版权所有 京ICP 备10216604号-4 海淀分局备案 1101084647
科技导报社主办 中国科协信息中心技术支持