艾司氯胺酮联合丙泊酚对老年髋关节置换术后神经炎症及认知的影响

Effects of esketamine combined with propofol on postoperative neuroinflammation and cognitive function in elderly patients undergoing total hip arthroplasty

目的 观察艾司氯胺酮联合丙泊酚对老年全髋关节置换患者术后神经炎症及认知功能的影响。方法 选取2020年1月至2022年3月安阳市中医院骨科收治的拟行全髋关节置换术的老年患者125例,随机分为单纯丙泊酚组(P组,n=61)和小剂量艾司氯胺酮联合丙泊酚组(E组,n=64)。P组麻醉维持采用单纯丙泊酚泵注,E组麻醉维持采用小剂量艾司氯胺酮联合丙泊酚泵注。分别比较两组在围术期血压及心率变化,并比较手术前后血清炎症因子、认知功能简易精神状态评分(MMSE)和术后不良反应的发生率。结果 纳入研究的P组患者61例因术中出血2例、失访2例,符合要求的研究对象为57例;E组患者64例因术中出血3例、拒绝使用镇痛泵1例及失访2例,符合要求的研究对象为58例。两组患者一般情况和手术情况比较差异无统计学意义(P均>0.05)。与P组相比,E组术中全麻药物明显减少,围术期血流动力学较为稳定,同时术后血清炎症因子显著下降,认知功能MMSE评分升高,术后恶心、呕吐、躁动等不良反应的发生率明显减少,差异具有统计学意义(P均<0.05)。两组患者术后镇痛泵舒芬太尼消耗量、不同时间点镇痛评分及术后髋关节活动度比较差异无统计学意义(P均>0.05)。结论 小剂量艾司氯胺酮联合丙泊酚麻醉维持能够减少老年患者全髋关节置换术镇静镇痛药物的用量,并能维持血流动力学稳定,保护患者的认知功能,减少阿片类药物相关并发症,更加安全有效。

Objective To observe the effect of esketamine combined with propofol on postoperative neuroinflammation and cognitive function in elderly patients undergoing total hip arthroplasty.Methods 125 elderly patients undergoing total hip arthroplasty from January 2020 to March 2022 in Anyang Hospital of Traditional Chinese Medicine were enrolled in the study. Patients were randomly divided into the propofol group(P group,n=61)and the low-dose esketamine group(E group,n=64). Patients in P group received propofol pump alone,while patients in E group received low-dose esketamine accompanied by propofol pump. The hemodynamic changes in two groups were compared,serum inflammatory factors,cognitive function(MMSE score),and the incidence of postoperative adverse reactions was observed. Results Among the 61patients in group P included in the study,2 cases were due to intraoperative bleeding,2 cases were lost to followup,and 57 cases met the requirements;64 patients in group E were included in the study due to intraoperative bleeding in 3 cases,1 case refused to use analgesic pump and lost follow-up. 2 cases were interviewed,and 58 cases met the requirements. There was no significant difference between the two groups in general conditions and surgical conditions(P>0.05). Compared with group P,in group E,intraoperative general anesthesia drugs were significantly reduced,perioperative hemodynamics were relatively stable,and postoperative serum inflammatory factors were significantly decreased,cognitive function MMSE scores were increased,postoperative nausea,vomiting,restlessness The incidence of adverse reactions was significantly reduced. The difference was statistically significant(all P<0.05). There was no significant difference in postoperative analgesic pump sufentanil consumption,analgesic scores at different time points,and postoperative hip joint range of motion between the two groups(P>0.05). Conclusion Low-dose esketamine accompanied by propofol can reduce the dosage of sedative and analgesic drugs,maintain hemodynamic stability and protect the cognitive function in elderly patients undergoing total hip arthroplasty,which is more effective and safer.