目的:观察老年髋关节置换术(THA)患者经氟比洛芬酯超前镇痛、艾司氯胺酮联合麻醉，患者术后认知功能、疼痛介质和氧化应激的变化情况。方法:采用随机数字表法将162例老年THA患者分为对照组(氟比洛芬酯超前镇痛)和研究组(艾司氯胺酮联合氟比洛芬酯超前镇痛)，每组各为81例。比较两组蒙特利尔认知评估量表(MoCA)、疼痛介质[前列腺素E2(PGE2)、P物质(SP)和β-内啡肽(β-EP)]、氧化应激指标[晚期氧化蛋白产物(AOPP)、脂质过氧化物(LPO)、谷胱甘肽过氧化物酶(GSH-Px)]和不良反应。结果:研究组术后3 d、术后7 d MoCA评分高于对照组(P＜0。05)。与对照组相比，研究组术后1 d SP、PGE2、LPO、AOPP更低，GSH-Px、β-EP更高(P＜0。05)。不良反应发生率对照组为8。64％，研究组为7。41％，比较无差异(P＞0。05)。结论:艾司氯胺酮联合氟比洛芬酯超前镇痛用于老年THA患者，可有效控制疼痛介质和氧化应激，减轻术后认知功能障碍，镇静、镇痛作用可靠。
Effects of Preemptive Analgesia with Esketamine Combined with Flurbiprofen Axetil on Postoperative Cognitive Function,Pain Mediators and Oxidative Stress in Elderly Patients Undergoing Hip Replacement Operation
Objective:To observe the changes of postoperative cognitive function,pain mediators and oxidative stress in elderly patients undergoing hip arthroplasty(THA)after preemptive analgesia with flurbiprofen axetil and combine anesthesia with esketamine.Methods:162 elderly THA patients were divided into control group(flurbiprofen axetil preemptive analgesia)and study group(eske-tamine combine with flurbiprofen axetil preemptive analgesia)by random number table method,81 cases in each group.The Montreal cognitive assessment scale(MoCA),pain mediators[prostaglandin E2(PGE2),substance P(SP)and β-endorphin(β-EP)],oxidative stress indexes[advanced oxidation protein products(AOPP),lipid peroxides(LPO),glutathione peroxidase(GSH-Px)]and adverse reactions were compared in two groups.Results:The MoCA score in study group was higher than that in control group at 3 days and 7 days after operation(P＜0.05).Compared with the control group,the study group had lower SP,PGE2,LPO,AOPP,while had higher GSH Px,andβ-EP(P＜0.05).The incidence of adverse reactions was 8.64％in the control group and 7.41％in the study group,there was no difference(P＞0.05).Conclusion:Preemptive analgesia with esketamine combined with flurbiprofen axetil for elderly THA patients,which can effectively control pain mediators and oxidative stress,reduce postoperative cognitive dysfunction,and have reliable sedative and anal-gesic effects.
EsketamineFlurbiprofen axetilPreemptive analgesiaElderlyTotal hip arthroplastyCognitive functionPain mediatorsOxidative stress
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