艾司氯胺酮超前镇痛对老年髋关节置换术患者术后恢复的影响

Effect of esketamine preemptive analgesia on postoperative recovery in elderly patients undergoing hip replacement

目的评价艾司氯胺酮超前镇痛对老年髋关节置换术患者术后恢复的影响。方法选择于本院行髋关节置换术的患者60例,采用随机数字表法将其分为对照组(C组)和艾司氯胺酮组(E组),每组30例。常规麻醉诱导与维持。E组于切皮前10 min时,静脉注射艾司氯胺酮0.3 mg/kg;C组给予等量生理盐水。术毕,采用静脉自控镇痛。于入室时(T_(0))、麻醉诱导结束后即刻(T_(1))、切皮时(T_(2))、气管拔管时(T_(3)),记录患者平均动脉压(mean arterial pressure,MAP)和心率(heart rate,HR);于术后12 h、1 d和2 d时记录患者术后恢复质量检测量表(postoperative quality of recovery scale,PQRS)、标准镇静评分表(level of sedation,LOS)评分和舒芬太尼用量;记录术中瑞芬太尼用量;记录患者术后严重不良事件的发生情况。结果与C组比较,E组患者T_(2),、T_(3)时的MAP和HR显著降低,术中瑞芬太尼用量也显著降低(P<0.05);与C组比较,E组患者术后12 h、1 d及2 d时的舒芬太尼用量显著降低,术后12 h和术后1 d时PQRS和LOS评分显著升高(P<0.05)。两组患者术后严重不良反应的发生情况差异无统计学意义(P>0.05)。结论艾司氯胺酮超前镇痛,可减少老年髋关节置换术患者围术期阿片类药物用量,提高术后恢复质量。

Objective To evaluate the effect of esketamine preemptive analgesia on postoperative recovery in elderly patients with hip replacement.Methods A total of 60 patients undergoing hip replacement in our hospital were enrolled and divided into control group(group C)and esketamine group(group E)using a random number table,with 30 cases in each group.Routine anesthesia induction and maintenance was performed.Group E was given 0.3 mg/kg of esketamine intravenously 10 minutes before skin incision,whereas the same amount of normal saline was given to group C.Patient controlled intravenous analgesia was used after the operation.MAP and HR were recorded at the time of admission(T_(0)),immediately after anesthesia induction(T_(1)),skin incision(T_(2)),and tracheal extubation(T_(3));the postoperative quality of recovery scale(PQRS)score,the sedation score of standard sedation scale(LOS)and sufentanil consumption on 12 h,1 d and 2 d after the operation were recorded.The occurrence of serious adverse events after operation was recorded.Results Compared with group C,MAP and HR at T_(2),T_(3)in group E were significantly lower,and the dosage of remifentanil during operation was also significantly lower(P<0.05);compared with group C,the dosage of sufentanil in group E was significantly reduced 12 h,1 d and 2 d after surgery,and the PQRS and LOS scores were significantly raised12 h and 1 d after surgery(P<0.05).There was no statistically significant difference in the occurrence of severe adverse reactions between the two groups of patients after surgery(P>0.05).Conclusion Esketamine preemptive analgesia can reduce the dosage of opioids used in the elderly patients undergoing hip replacement perioperatively and improve the quality of postoperative recovery.