摘要
目的 观察丙泊酚复合艾司氯胺酮在老年全髋关节置换术(THA)中的应用效果.方法 选择2020年6月至2023年6月安徽省皖南康复医院·芜湖市第五人民医院收治的老年THA患者102例,按随机数字表法将102例老年THA患者分为两组.对照组(n=51)麻醉维持泵注丙泊酚5 mg·kg-1·h-1+苯磺顺阿曲库铵0.2 mg·kg-1·h-1+瑞芬太尼30 μg·kg-1·h-1,研究组(n=51)麻醉维持泵注艾司氯胺酮0.2 mg·kg-1·h-1+丙泊酚5 mg·kg-1·h-1+苯磺顺阿曲库铵0.2 mg·kg-1·h-1+瑞芬太尼30 μg·kg-1·h-1.比较两组镇痛效果、髋关节活动度、认知功能、炎症因子、应激反应、不良反应发生情况.结果 研究组的术后24 h静息时视觉模拟量表(VAS)评分、术后48 h静息时VAS评分、术后24 h活动时VAS评分、术后48 h活动时VAS评分、镇痛泵舒芬太尼用量、不良反应发生率[分别为(3.16±0.67)分、(1.84±0.45)分、(6.48±1.12)分、(5.46±1.03)分、(94.56±10.71)μg、呼吸抑制发生率0、恶心发生率3.92%、呕吐发生率0、躁动发生率5.88%、低氧血症发生率0]均低于对照组[分别为(3.54±0.78)分、(2.28±0.63)分、(7.09±1.04)分、(6.11±0.92)分、(101.78±15.93)μg、呼吸抑制发生率11.76%、恶心发生率19.61%、呕吐发生率11.76%、躁动发生率21.57%、低氧血症发生率11.76%](t=2.639、4.059、2.850、3.361、2.686,χ2=4.427、6.044、4.427、5.299、4.427,均P＜0.05),髋关节最大屈曲度、最大外展活动度[分别为(80.53±7.51)°、(51.56±5.38)°]较对照组[分别为(78.29±6.64)°、(53.73±8.15)°]差异无统计学意义(t=1.596、1.587,均P＞0.05).术后24 h,两组简易精神状态检查表(MMSE)评分均低于术前(P＜0.05),且研究组[(26.78±1.23)分]高于对照组[(22.73±2.48)分](t=10.448,P＜0.05).术后24 h,两组肿瘤坏死因子-α(TNF-α)、C反应蛋白(CRP)、白细胞介素6(IL-6)、皮质醇(Cor)、肾上腺素(E)、去甲肾上腺素(NE)均高于术前(P＜0.05),且研究组[分别为(594.98±41.37)pg·mL-1、(8.52±2.78)pg·mL-1、(41.85±10.37)ng·L-1、(436.13±60.62)ng·mL-1、(0.67±0.16)nmol·L-1、(1.84±0.41)nmol·L-1]低于对照组[分别为(727.52±49.46)pg·mL-1、(15.74±3.62)pg·mL-1、(57.29±13.43)ng·L-1、(479.94±66.28)ng·mL-1、(0.78±0.19)nmol·L-1、(2.11±0.45)nmol·L-1](t=14.679、11.297、6.498、3.483、3.163、3.167,均P＜0.05).结论 艾司氯胺酮能够为老年THA患者提供确切镇痛效果,可减轻认知功能损害、应激反应,降低炎症因子水平,减少不良反应,且不影响髋关节活动度.
Abstract
Objective To investigate the clinical efficacy of propofol combined with esketamine in elderly patients undergoing total hip arthroplasty(THA).Methods A total of 102 elderly patients with THA admitted to Wuhu Fifth People's Hospital from June 2020 to June 2023 were enrolled in this study and divided into 2 groups using the random number table method.The control group(n=51)was given propofol about 5 mg·kg-1·h-1+cisatracurium besilate about 0.2 mg·kg-1·h-1+remifentanil about 30 μg·kg-1·h-1 during anesthesia maintenance stage.The study group(n=51)received esketamine 0.2 mg·kg-1·h-1+propofol 5 mg·kg-1·h-1+cisatracurium besilate 0.2 mg·kg-1·h-1+remifentanil 30 μg·kg-1·h-1 at the maintenance stage of anesthesia.Analgesic effects,hip joint range of motion,cognitive function,inflammatory factors,stress reactions and adverse reactions were compared between the two groups.Results The resting visual analogue scale(VAS)score at 24 hours after surgery,the resting VAS score at 48 hours after surgery,VAS score at 24 hours of postoperative activity,VAS score at 48 hours of postoperative activity,the dosage of analgesic pump sufentanil,and the incidence of adverse reactions in the study group were(3.16±0.67)points,(1.84±0.45)points,(6.48±1.12)points,(5.46±1.03)points,(94.56±10.71)μg,0%for respiratory depression,3.92%for nausea,0%for vomiting,5.88%for agitation and 0%for hypoxia,respectively,which were all lower than those in the control((3.54±0.78)points,(2.28±0.63)points,(7.09±1.04)points,(6.11±0.92)points,(101.78±15.93)μg,11.76%for respiratory depression,19.61%for nausea,11.76%for vomiting,21.57%for agitation and 11.76%for hypoxia)(t=2.639,4.059,2.850,3.361,2.686,χ2=4.427,6.044,4.427,5.299,4.427,all P＜0.05).There was no statistically significant difference in maximum hip joint flexion and maximum abduction activity between the two groups((80.53±7.51)° vs 78.29±6.64)°,(51.56±5.38)° vs(53.73±8.15)°)(t=1.596,1.587,all P＞0.05).Twenty-four hours after surgery,the score of Mini Mental State Examination(MMSE)in both groups was lower than that before surgery(P＜0.05),and it was higher in the study group than in the control((26.78±1.23)points vs(22.73±2.48)points)(t=10.448,P＜0.05).At 24h after operation,the levels of tumor necrosis factor-α(TNF-α),C-reactive protein(CRP),interleukin-6(IL-6),cortisol(Cor),epinephrine(E)and norepinephrine(NE)in both groups were higher than those before operation(P＜0.05),they were(594.98±41.37)pg·mL-1,(8.52±2.78)pg·mL-1,(41.85±10.37)ng·L-1,(436.13±60.62)ng·mL-1,(0.67±0.16)nmol·L-1,(1.84±0.41)nmol·L-1 in the study group,which were smaller than those in the control((727.52±49.46)pg·mL-1,(15.74±3.62)pg·mL-1,(57.29±13.43)ng·L-1,(479.94±66.28)ng·mL-1,(0.78±0.19)nmol·L-1,(2.11±0.45)nmol·L-1)(t=14.679,11.297,6.498,3.483,3.163,3.167,all P＜0.05).Conclusion Esketamine can provide exact analgesic efficacy for elderly patients with THA by reducing cognitive impairment,stress reaction,inflammatory factor level and adverse reactions,and not affecting hip joint mobility.
基金项目
2021年度芜湖市科技计划项目(2021cg50)
维普
万方数据