摘要

【摘要】
目的 探讨艾司氯胺酮复合右美托咪定竖脊肌平面阻滞对肺叶切除患者术后神经心理指标的影响。

方法 选取2024年10月～2025年4月行肺叶切除术的110例肺癌患者，按照麻醉方式的不同分为阻滞组54例、复合组56例。阻滞组行右美托咪定复合罗哌卡因竖脊肌平面阻滞，复合组在阻滞组基础上联用艾司氯胺酮。比较两组术后Ramsay镇静评分，术前及术后1 d、3 d睡眠质量（PSQI、AIS量表）、认知功能（MMSE量表）、负性情绪（DASS-21量表）、神经功能标志物水平及不良反应。

结果 复合组术后2 h、4 h、12 h Ramsay评分显著高于阻滞组（P<0.05）；两组术后1 d、3 d PSQI、AIS评分降低，MMSE评分升高，且复合组改善幅度更显著（P<0.05）；两组术后DASS-21量表各维度得分均低于术前，且复合组低于阻滞组（P<0.05）；复合组术后1 d、3 d血清NfL、GFAP水平显著低于阻滞组，BDNF水平显著高于阻滞组（P<0.05）；两组不良反应发生率比较无统计学意义（P>0.05）。

结论 艾司氯胺酮复合右美托咪定竖脊肌平面阻滞可提升肺癌肺叶切除患者术后镇静效果，改善术后认知功能与睡眠质量，减轻围术期负性情绪，发挥神经保护作用，优化术后精神相关状态，且安全性良好。

关键词：【关键词】艾司氯胺酮；右美托咪定；竖脊肌平面阻滞；肺癌；肺叶切除术；认知功能

ABSTRACT

[Abstract]
Objective: To investigate the effects of esketamine combined with dexmedetomidine erector spinae plane block on postoperative neuropsychological indicators in patients undergoing lobectomy.

Methods: A total of 110 lung cancer patients who underwent lobectomy from October 2024 to April 2025 were selected and divided into the block group (54 cases) and the combined group (56 cases) according to different anesthesia methods. The block group received right dexmedetomidine combined with ropivacaine erector spinae plane block, while the combined group additionally received esketamine based on the block group. Postoperative Ramsay sedation scores, preoperative and postoperative sleep quality (PSQI, AIS scales) at days 1 and 3, cognitive function (MMSE scale), negative emotions (DASS-21 scale), levels of neurological biomarkers, and adverse reactions were compared between the two groups.

Results: The Ramsay scores at 2 h, 4 h, and 12 h postoperatively in the combined group were significantly higher than those in the block group (P<0.05); the PSQI and AIS scores decreased and the MMSE scores increased at 1 day and 3 days postoperatively in both groups, with the improvement being more significant in the combined group (P<0.05); the DASS-21 scale scores in all dimensions were lower than preoperatively in both groups, and the combined group scores were lower than those of the block group (P<0.05); serum NfL and GFAP levels in the combined group at 1 day and 3 days postoperatively were significantly lower than those in the block group, while BDNF levels were significantly higher than those in the block group (P<0.05); there was no statistically significant difference in the incidence of adverse reactions between the two groups (P>0.05).

Conclusion  : The combination of esketamine and dexmedetomidine in erector spinae plane block can enhance postoperative sedation in patients undergoing lobectomy for lung cancer, improve postoperative cognitive function and sleep quality, alleviate perioperative negative emotions, exert neuroprotective effects, optimize postoperative mental-related status, and has good safety.

Key words: 【Keywords】esketamine; dexmedetomidine; erector spinae plane block; lung cancer; lobectomy; postoperative cognitive function