Analgesic efficacy of esketamine in elderly patients undergoing total hip arthroplasty and its influence on cognitive function and stress response
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.
Total hip arthroplastyElderlyEsketamineAnalgesic efficacyCognitive functionStress response
万方数据
维普
