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中华肺部疾病杂志(电子版)

中华肺部疾病杂志(电子版) ›› 2026, Vol. 19 ›› Issue (04) : 663 -669. doi: 10.3877/cma.j.issn.1674-6902.2026.04.020

论著

艾司氯胺酮联合胸腔镜引导胸椎旁阻滞对肺癌肺叶切除术后恢复与镇痛药物用量的影响
乔山青1,†(), 张凤凯1, 方剑1, 张宏江1, 薛瑞2   
  1. 1519000　珠海，珠海市中西医结合医院麻醉科
    2519000　珠海，珠海市中西医结合医院心胸外科
  • 收稿日期:2026-03-01 出版日期:2026-08-25
  • 通信作者: 乔山青

Effect of esketamine combined with thoracoscopic-guided thoracic paravertebral block on recovery and analgesic consumption after lobectomy for bronchogenic carcinoma

Shanqing Qiao1,†(), Fengkai Zhang1, Jian Fang1, Hongjiang Zhang1, Rui Xue2   

  1. 1Department of Anesthesiology, Zhuhai Hospital of Integrated Traditional Chinese and Western Medicine, Zhuhai 519000, China
    2Department of Cardiothoracic Surgery, Zhuhai Hospital of Integrated Traditional Chinese and Western Medicine, Zhuhai 519000, China
  • Received:2026-03-01 Published:2026-08-25
  • Corresponding author: Shanqing Qiao
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引用本文：

乔山青, 张凤凯, 方剑, 张宏江, 薛瑞. 艾司氯胺酮联合胸腔镜引导胸椎旁阻滞对肺癌肺叶切除术后恢复与镇痛药物用量的影响[J/OL]. 中华肺部疾病杂志(电子版), 2026, 19(04): 663-669.

Shanqing Qiao, Fengkai Zhang, Jian Fang, Hongjiang Zhang, Rui Xue. Effect of esketamine combined with thoracoscopic-guided thoracic paravertebral block on recovery and analgesic consumption after lobectomy for bronchogenic carcinoma[J/OL]. Chinese Journal of Lung Diseases(Electronic Edition), 2026, 19(04): 663-669.

目的

探讨艾司氯胺酮联合胸腔镜引导胸椎旁阻滞(thoracoscopic-guided thoracic paravertedbral block, TTPB)对肺癌肺叶切除术后恢复质量及镇痛药物用量的影响。

方法

选取2022年1月至2025年9月我院收治的行胸腔镜肺叶切除术肺癌患者72例，根据围术期镇痛方案分为观察组35例和对照组37例，观察组艾司氯胺酮持续静脉泵注联合胸腔镜引导胸椎旁阻滞；对照组等量生理盐水联合胸腔镜引导胸椎旁阻滞。比较两组术后恢复质量评分(quality of recovery15, QoR-15)、术后不同时间点静息及活动时视觉模拟评分法(visual analogue scale, VAS)评分、拔管时间、首次下床活动时间、住院时间、术后48 h内患者自控静脉镇痛泵(patientcontrolled intravenous analgesia, PCIA)按压次数、补救镇痛药物用量及不良反应发生。

结果

两组术后24 h及48 h，观察组QoR-15评分高于对照组[(82.36±5.78)分比(73.12±6.05)分，(91.45±4.32)分比(82.67±5.11)分，t＝7.241、8.604，P<0.001]。术后6、12、24、48 h，观察组静息时VAS评分低于对照组[(3.12±0.89)分比(4.56±0.98)分、(2.78±0.76)分比(3.98±0.87)分、(2.41±0.65)分比(3.23±0.78)分、(1.64±0.54)分比(2.21±0.67)分，t＝7.133、6.812、5.296、4.344，P<0.001]；活动时VAS评分低于对照组[(4.23±1.01)分比(5.89±1.12)分、(3.78±0.92)分比(5.12±1.03)分、(3.32±0.85)分比(4.34±0.98)分、(2.51±0.76)分比(3.12±0.89)分，t＝7.218、6.363、5.156、3.418，P<0.001]。观察组拔管时间[(18.76±4.32)min比(25.45±5.11)min，t＝6.556，P<0.001]、首次下床活动时间[(22.34±5.67)min比(30.12±6.05)min，t＝6.153，P<0.001]、住院时间[(6.89±1.23)d比(8.76±1.54)d，t＝6.222，P<0.001]短于对照组。观察组术后24 h PCIA总按压次数[(4.32±1.23)次比(8.98±1.98)次，t＝13.110，P<0.001]、48 h PCIA总按压次数[(7.89±1.87)次比(15.67±2.76)次，t＝15.303，P<0.001]、有效按压次数[(3.78±1.01)次比(8.98±1.56)次，t＝18.348，P<0.001]及补救镇痛药物用量[(25.67±8.98)mg比(58.98±12.34)mg，t＝14.312，P<0.001]少于对照组。观察组不良反应发生率9.30%，对照组13.33%(P>0.05)。

结论

艾司氯胺酮联合胸腔镜引导胸椎旁阻滞可提升胸腔镜肺癌肺叶切除术后患者恢复质量，增强镇痛效果，减少术后阿片类镇痛药物用量，加速康复进程，安全性良好，不良反应发生率未增加。

关键词: 支气管肺癌, 肺叶切除术, 艾司氯胺酮, 胸椎旁神经阻滞，胸腔镜引导, 镇痛药物用量
Objective

To investigate the effect of esketamine combined with thoracoscopic-guided thoracic paravertebral block (TTPB) on the quality of recovery and analgesic consumption after lobectomy for lung cancer.

Methods

Seventy-two patients with lung cancer who underwent thoracoscopic lobectomy in our hospital from January 2022 to September 2025 were selected. According to the perioperative analgesia regimen, they were divided into an observation group 35 cases and a control group 37 cases. The observation group received continuous intravenous infusion of esketamine combined with thoracoscopic-guided thoracic paravertebral block, while the control group received an equal volume of normal saline combined with thoracoscopic-guided thoracic paravertebral block. The quality of recovery-15 (QoR-15) scores, visual analogue scale (VAS) scores at rest and during activity at different time points after surgery, extubation time, time to first ambulation, length of hospital stay, number of patient-controlled intravenous analgesia (PCIA) bolus attempts within 48 h after surgery, rescue analgesic consumption, and incidence of adverse reactions were compared between the two groups.

Results

At 24 h and 48 h after surgery, the QoR-15 scores in the observation group were higher than those in the control group [(82.36±5.78) vs. (73.12±6.05), (91.45±4.32) vs. (82.67±5.11); t=7.241, 8.604; P<0.001]. At 6, 12, 24, and 48 h after surgery, the resting VAS scores in the observation group were lower than those in the control group [(3.12±0.89) vs. (4.56±0.98), (2.78±0.76) vs. (3.98±0.87), (2.41±0.65) vs. (3.23±0.78), (1.64±0.54) vs. (2.21±0.67); t=7.133, 6.812, 5.296, 4.344; P<0.001]. The VAS scores during activity in the observation group were also lower than those in the control group [(4.23±1.01) vs. (5.89±1.12), (3.78±0.92) vs. (5.12±1.03), (3.32±0.85) vs. (4.34±0.98), (2.51±0.76) vs. (3.12±0.89); t=7.218, 6.363, 5.156, 3.418; P<0.001]. The extubation time [(18.76±4.32) min vs. (25.45±5.11) min; t=6.556, P<0.001], time to first ambulation [(22.34±5.67) min vs. (30.12±6.05) min; t=6.153, P<0.001], and length of hospital stay [(6.89±1.23) d vs. (8.76±1.54) d; t=6.222, P<0.001] in the observation group were shorter than those in the control group. The total number of PCIA bolus attempts at 24 h [(4.32±1.23) vs. (8.98±1.98); t=13.110, P<0.001], the total number at 48 h [(7.89±1.87) vs. (15.67±2.76); t=15.303, P<0.001], the number of effective bolus deliveries [(3.78±1.01) vs. (8.98±1.56); t=18.348, P<0.001], and rescue analgesic consumption [(25.67±8.98) mg vs. (58.98±12.34) mg; t=14.312, P<0.001] were all lower in the observation group than in the control group. The incidence of adverse reactions was 9.30% in the observation group and 13.33% in the control group (P>0.05).

Conclusion

Esketamine combined with thoracoscopic-guided thoracic paravertebral block can improve the quality of recovery after thoracoscopic lobectomy for lung cancer, enhance analgesic efficacy, reduce postoperative opioid analgesic consumption, and accelerate recovery, with a good safety profile and no increase in the incidence of adverse reactions.

Key words: Bronchogenic carcinoma, Lobectomy, Esketamine, Thoracic paravertebral nerve block, thoracoscopic-guided, Analgesic consumption
图1 术中肋间神经阻滞
表1 两组肺癌患者临床资料结果
临床资料 观察组(n＝35) 对照组(n＝37) χ2/t值 P值
性别[n(%)]     0.044 0.833
男 19(54.29) 21(56.76)    
女 16(45.71) 16(43.24)    
BMI[kg/m2，(±s)] 23.45±2.11 22.98±2.34 0.894 0.374
ASA分级[n(%)]     0.069 0.792
Ⅰ级 20(58.14) 20(54.05)    
Ⅱ级 15(41.86) 17(45.95)    
肺癌类型[n(%)]     0.172 0.679
肺腺癌 23(65.71) 26(70.27)    
肺鳞癌 12(34.29) 11(29.73)    
实验室检查指标(±s)        
ALT(U/L) 30.66±5.82 32.52±5.32 1.563 0.122
AST(U/L) 29.74±6.33 27.41±7.74 1.549 0.125
TBIL(μmol/L) 13.78±4.61 14.63±4.79 0.848 0.399
BUN(mmol/L) 8.72±2.86 8.04±2.57 1.171 0.245
Cr(μmol/L) 114.78±10.78 110.64±13.23 1.612 0.111
UA(μmol/L) 308.45±37.79 320.12±32.23 1.555 0.124
手术参数(±s)        
手术时间(min) 128.34±15.67 132.15±14.98 1.152 0.252
术中出血量(ml) 89.45±18.76 92.34±17.89 0.731 0.467
图2 肺癌患者典型胸部CT图
表2 两组肺癌患者术后VAS评分比较[分，(±s)]
组　别 例数 静息时 活动时
术后6 h 术后12 h 术后24 h 术后48 h 术后6 h 术后12 h 术后24 h 术后48 h
观察组 35 3.12±0.89 2.78±0.76 2.41±0.65 1.64±0.54 4.23±1.01 3.78±0.92 3.32±0.85 2.51±0.76
对照组 37 4.56±0.98 3.98±0.87 3.23±0.78 2.21±0.67 5.89±1.12 5.12±1.03 4.34±0.98 3.12±0.89
t值   7.133 6.812 5.296 2.930 7.218 6.363 5.156 3.093
P值   0.000 0.000 0.000 0.004 0.000 0.000 0.000 0.002
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