艾司氯胺酮联合腰丛坐骨神经阻滞在老年膝关节置换的应用

Application of esmketamine combined with lumbar plexus sciatic nerve block in elderly patients undergoing total knee arthroplasty

目的探讨艾司氯胺酮联合腰丛坐骨神经阻滞在老年膝关节置换的应用。方法选取2020年4月至2022年4月本院拟行膝关节置换术的60例老年患者作为研究对象,按照随机数字表法分为A组、B组与C组,各20例。A组采用艾司氯胺酮联合腰丛坐骨神经阻滞麻醉,B组采用单纯硬膜外阻滞麻醉,C组采用气管内插管全身麻醉,比较3组不同时间的生命体征指标[收缩压(SBP)、舒张压(DBP)及心率(HR)]及术后48 h内并发症发生情况。结果3组SBP、DBP、HR组间、时间、交互比较差异有统计学意义(P<0.05)。组内比较:T0、T1、T3、T4时,A组SBP、DBP、HR比较差异无统计学意义,B、C组SBP、DBP均先降低后升高,HR均先降低后升高再降低,差异有统计学意义(P<0.05)。组间比较:T0、T1、T4时,B组、C组SBP、DBP、HR比较差异无统计学意义;T1、T2、T3时,A组SBP、DBP均高于B、C组,差异有统计学意义(P<0.05);T1、T4时,A组HR快于B、C组,差异有统计学意义(P<0.05);T2、T3时,A组HR慢于B、C组,差异有统计学意义(P<0.05);T3时,B组、C组SBP、HR比较差异无统计学意义,B组DBP低于C组,差异有统计学意义(P<0.05);T4时,A组SBP高于B、C组,DBP低于B组,差异有统计学意义(P<0.05),A组与C组DBP比较差异无统计学意义。A组并发症发生率低于B组、C组,差异有统计学意义(P<0.05);B组、C组并发症发生率比较差异无统计学意义。结论艾司氯胺酮联合腰丛坐骨神经阻滞麻醉对老年膝关节置换术中麻醉效果显著,保障术中生命体征,减少并发症的发生风险,术后恢复较快,值得临床推广应用。

Objective To explore the application of esmketamine combined with lumbar plexus sciatic nerve block in elderly patients undergoing total knee arthroplasty.Methods 60 elderly patients who planned to undergo knee arthroplasty in our hospital from April 2020 to April 2022 were selected as the research subjects and they were divided into group A,group B and group C according to the random number table method,with 20 cases in each group.Group A was treated with esmketamine and lumbar plexus sciatic nerve block anesthesia,group B was treated with epidural block anesthesia,and group C was treated with endotracheal intubation general anesthesia,the vital signs(systolic blood pressure[SBP],diastolic blood pressure[DBP]and heart rate[HR])at different times and complications within 48 hours after operation were compared among the three groups.Results There were significant differences in SBP,DBP and HR among the three groups,time and interaction(P<0.05);Intra-group comparison:at T0,T1,T3 and T4,there was no significant difference in SBP,DBP and HR in group A,SBP and DBP in group B and C decreased first and then increased,HR decreased first and then increased and then decreased,and the difference was statistically significant(P<0.05).Inter-group comparison:at T0,T1 and T4,there was no significant difference in SBP,DBP and HR between group B and group C;at T1,T2 and T3,SBP and DBP in group A were higher than those in group B and C,and the differences were statistically significant(P<0.05);at T1 and T4,HR in group A was faster than that in group B and group C,and the difference was statistically significant(P<0.05);at T2 and T3,HR in group A was slower than that in group B and group C,and the difference was statistically significant(P<0.05);at T3,there was no significant difference in SBP and HR between group B and group C,while DBP in group B was lower than that in group C,and the difference was statistically significant(P<0.05);at T4,the SBP in group A was higher than that of group B and group C,and the DBP was lower than that in group B,and the difference was statistically significant(P<0.05),there was no significant difference in DBP between group A and group C.The incidence of complications in group A was lower than that in group B and group C,the difference was statistically significant(P<0.05),there was no significant difference in the incidence of complications between group B and group C.Conclusion Esmketamine combined with lumbar plexus sciatic nerve block anesthesia has significant anesthetic effect on elderly patients undergoing total knee arthroplasty,which can ensure intraoperative vital signs,reduce the risk of complications,and achieve rapid postoperative recovery,which is worthy of clinical application.