艾司氯胺酮辅助静脉全身麻醉在老年全膝关节置换术患者中的应用效果

Effects of Esketamine-assisted intravenous general anesthesia in elderly patients undergoing total knee arthroplasty

目的:探讨艾司氯胺酮辅助静脉全身麻醉在老年全膝关节置换术(TKA)患者中的应用效果。方法:选取2021年6月至2023年6月在该院行TKA治疗的280例老年膝关节病患者进行前瞻性研究,按随机数字表法将其分为研究组与对照组各140例。对照组采用常规静脉全身麻醉(丙泊酚+瑞芬太尼+苯磺酸阿曲库铵),研究组在对照组基础上联用小剂量艾司氯胺酮进行麻醉,术后均采用舒芬太尼进行静脉自控泵镇痛。比较两组术中丙泊酚和术后舒芬太尼用量,术后疼痛[视觉模拟评分法(VAS)]评分,手术前后认知功能[蒙特利尔认知评估量表(MoCA)]评分、应激反应指标[白细胞介素-6(IL-6)、肾上腺素、去甲肾上腺素]水平,以及不良反应发生率。结果:研究组术中丙泊酚用量和术后舒芬太尼用量均少于对照组,差异有统计学意义(P<0.05);研究组术后6、24、48 h的VAS评分及术后即刻血清去甲肾上腺素、肾上腺素、IL-6水平均低于对照组,差异有统计学意义(P<0.05);两组术后MoCA评分均低于术前,但研究组高于对照组,差异有统计学意义(P<0.05);研究组不良反应发生率为5.00%(7/140),低于对照组的15.71%(22/140),差异有统计学意义(P<0.05)。结论:艾司氯胺酮辅助静脉全身麻醉用于老年TKA患者可提高麻醉效果,减轻术后疼痛和应激反应,保护术后认知功能,还可减少丙泊酚、舒芬太尼用量,降低不良反应发生率,效果优于常规静脉全身麻醉。

Objective:To investigate effects of Esketamine-assisted intravenous general anesthesia in elderly patients undergoing total knee arthroplasty(TKA).Methods:A prospective study was conducted on 280 elderly patients with knee joint disease who underwent TKA in this hospital from June 2021 to June 2023.They were divided into study group and control group according to the random number table method,140 cases in each.The control group was treated with conventional intravenous general anesthesia(Propofol+Remifentanil+Atracurium besylate),while the study group was treated with low-dose Esketamine on the basis of that of the control group.Sufentanil was used for patient-controlled intravenous analgesia after the surgery.The dosage of intraoperative Propofol and postoperative Sufentanil,the postoperative pain[visual analogue scale(VAS)]score,the preoperative and postoperative cognitive function[Montreal cognitive assessment(MoCA)]scores,the stress response indicators[interleukin-6(IL-6),epinephrine,norepinephrine]levels,and the incidence of adverse reactions were compared between the two groups.Results:The dosages of intraoperative Propofol and postoperative Sufentanil in the study group were less than those in the control group,and the differences were statistically significant(P<0.05).The VAS scores 6,24 and 48 h after the surgery and the levels of serum norepinephrine,epinephrine and IL-6 immediately after the surgery in the study group were lower than those in the control group,and the differences were statistically significant(P<0.05).The MoCA scores of the two groups after the surgery were lower than those before operation,but that of the study group was higher than that of the control group,and the differences were statistically significant(P<0.05).Further,the incidence of adverse reactions in the study group was 5.00%(7/140),which was lower than 15.71%(22/140)in the control group,and the difference was statistically significant(P<0.05).Conclusions:Esketamine-assisted intravenous general anesthesia for the elderly patients with TKA can improve the anesthetic effects,reduce the postoperative pain and the stress reactions,protect the postoperative cognitive function,and reduce the dosage of Propofol and Sufentanil,and reduce the incidence of adverse reactions.Moreover,it is superior to conventional intravenous general anesthesia.