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
10.12122/j.issn.1673-4254.2024.03.09
- VernacularTitle: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
- Author:
Yang YANG
1
;
Gang LIU
;
Yi OU
;
Wenqi LU
Author Information
1. 蚌埠医科大学第一附属医院麻醉科,安徽 蚌埠 233000
- Keywords:
esketamine;
distal limb ischemia pretreatment;
lung cancer;
lung injury;
lung protection;
thoracoscopic radical lung cancer
- From:
Journal of Southern Medical University
2024;44(3):484-490
- CountryChina
- Language:Chinese
-
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.
