硬膜外氯胺酮复合可乐定对髋关节置换术患者应激反应的影响

Effects of epidural ketamine and clonidine on stress response in total hip replacement

目的探讨氯胺酮复合可乐定硬膜外给药对髋关节置换术患者应激反应的影响，探讨其可能的作用机制。方法择期行髋关节置换术患者45例，ASAⅡ～Ⅲ级，随机分成A组硬膜外给予利多卡因；B组硬膜外给予利多卡因＋氯胺酮；C组硬膜外给予利多卡因＋氯胺酮＋可乐定，每组15例。各组均采用L2-3间隙硬膜外穿刺，抽取不同时点静脉血测血糖、皮质醇、肿瘤坏死因子-α、血管紧张素U水平。结果术中各指标均升高，A组血糖、皮质醇及血管紧张素Ⅱ均于切皮时开始升高，骨水泥放置时达高峰，且术中各时点明显高于B、C组。结论氯胺酮复合可乐定硬膜外给药用于髋关节置换术能改善术后免疫抑制时间和程度，降低患者术中术后应激反应。

Objective To observe the effects of epidural ketamine and clonidine on stress response in total hip replacement and explore its possible mechanism. Methods 45 patients grading ASA Ⅱ-Ⅲ and undergoing selective THR operation were randomly divided into 3 groups （15 cases in each one）. The patients were epidurally injected with 2% lidocaine in group A, lidocain and ketamine in group B and lidocaine, ketamine and elonidine in group C. All patients were accepted epidural analgesia at L2-3. The blood sugar, eortisol, tumor necrosis factor-α and angiotesin-Ⅱ were measured at different time. Results All indexes were increased during operation. Blood sugar, cortisol and angiotensin-Ⅱ were increased at incision and reached the peak at the moment disposing bone cement, which in group was more than that in group B and C. Conclusion The application of ketamine combined with clonidine for THR can remarkably improve the time and the degree of immune response and reduce the stress response.