艾司氯胺酮对虚弱患者全髋关节置换术后镇痛及炎症因子的影响

Effect of esketamine on postoperative pain and inflammatory factors of patients with frailty after total hip replacement arthroplasty

目的:探讨术中静脉应用艾司氯胺酮对虚弱患者全髋关节置换术(total hip arthroplasty, THA)后镇痛效果及炎症因子的影响。方法:选择接受全身麻醉下THA的虚弱患者70例,按照随机数字表法分为艾司氯胺酮组(K组)和对照组(C组),每组35例。K组于麻醉诱导前10 min予以艾司氯胺酮静脉泵注(15 μg·kg -1·min -1)至手术结束前10 min, C组予以生理盐水相同速度静脉泵注,其余麻醉方法与K组相同。记录两组患者手术时间、麻醉时间、术中失血量及丙泊酚和瑞芬太尼用量,术后苏醒时间、拔管时间和言语对答时间,术后2、6、12 h和24 h的静息VAS疼痛评分;于术前和术后1 h留取静脉血测定两组患者C-反应蛋白(C-reactive protein, CRP)、TNF-α和IL-6的水平;记录两组患者术后首次下床活动时间、术后第7天髋关节Harris评分、术后48 h内镇痛泵舒芬太尼用量、术后住院时间以及术后并发症发生情况。 结果:与C组比较,K组患者术中丙泊酚用量和瑞芬太尼用量均明显降低( P<0.05)。两组患者手术时间、麻醉时间、术中失血量、苏醒时间、拔管时间和言语对答时间比较差异无统计学意义( P>0.05)。K组术后2、6 h和12 h时静息VAS疼痛评分低于C组( P<0.05);两组患者术后24 h时静息VAS疼痛评分差异无统计学意义( P>0.05)。两组患者术后1 h的CRP、TNF-α和IL-6水平较术前增高( P<0.05),K组术后1 h的CRP、TNF-α和IL-6水平均低于C组( P<0.05)。K组术后首次下床活动时间和术后住院时间明显短于C组( P<0.05);K组术后第7天髋关节Harris评分明显高于C组,术后48 h内镇痛泵舒芬太尼用量明显低于C组( P<0.05)。K组术后并发症总发生率低于C组( P<0.05)。 结论:术中静脉应用艾司氯胺酮能够减轻虚弱患者THA术后疼痛,同时可以降低炎症因子水平,促进术后早期康复。

Objective To investigate the effect of intravenous administration of esketamine on postoperative pain and inflammatory factors of patients with frailty undergoing total hip arthroplasty(THA).Methods A total of 70 patients with frailty who underwent THA under general anesthesia were selected.According to the random number table method,they were divided into two groups(n=35):an esketamine group(group K)and a control group(group C).Group K received intravenous infusion of esketamine(15µg·kg-1·min-1)10 min before anesthesia induction until 10 min before surgery,while group C was intravenously pumped with the same volume of normal saline,with other treatment that were the same as those in group K.Both groups were compared for their operation time,anesthesia time,intraoperative blood loss,the consumption of propofol and remifentanil during surgery,recovery time,extubation time,and the time to straight answer.Their resting Visual Analog Scale(VAS)scores 2,6,12 h and 24 h after surgery were recorded.Their venous blood samples were collected to measure the levels of C-reactive protein(CRP),tumor necrosis factor-α(TNF-α),and interleukin-6(IL-6)before surgery and 1 h after surgery.The time of first off-bed activity,Harris hip joint function scores on day 7 after surgery,the consumption of sufentanil within 48 h after surgery,the length of hospitalization stay,and post-operative complications were also recorded.Results Compared with group C,the consumption of propofol and remifentanil in group K remarkably decreased(P<0.05).There was no statistical difference in operation time,anesthesia time,intraoperative blood loss,recovery time,extubation time and the time to straight answer between the two groups(P>0.05).The resting VAS scores in group K 2,6 h and 12 h after surgery were lower than those in group C(P<0.05),while no statistical difference was found in resting VAS scores 24 h after surgery(P>0.05).The levels of CRP,TNF-αand IL-6 in the two groups 1 h after surgery were significantly higher than those before surgery(P<0.05).Compared with group C,group K presented remarkable decreases in the levels of CRP,TNF-α,and IL-61 h after surgery(P<0.05).Compared with group C,group K presented remarkable decreases in the time of first off-bed activity after surgery and the length of hospitalization stay(P<0.05),increases in Harris hip joint function scores on day 7 after surgery and decreases in the consumption of sufentanil within 48 h after surgery(P<0.05).The incidence of post-operative complications were lower in group K than those in group C(P<0.05).Conclusions Intravenous administration of esketamine can exert a better postoperative analgesic effect,reduce inflammatory factors and promote early postoperative recovery in patients with frailty after total hip replacement arthroplasty.