艾司氯胺酮无阿片全身麻醉对老年全髋关节置换术患者神经源炎性因子、脑氧代谢、麻醉及苏醒质量的影响

Effects of Opioid-free General Anesthesia with Esketamine on Neurogenic Inflammatory Factors,Cerebral Oxygen Metabolism,Anesthesia and Recovery Quality in Elderly Patients Undergoing Total Hip Arthroplasty

目的探讨艾司氯胺酮无阿片全身麻醉对老年全髋关节置换术(THR)患者神经源炎性因子、脑氧代谢、麻醉及苏醒质量的影响。方法选取2022年4月—2023年4月择期行THR的老年患者86例,随机将其分为观察组和对照组2组各43例。观察组行艾司氯胺酮无阿片麻醉,对照组行常规麻醉。比较2组麻醉诱导前、气管插管时(T2)、切皮时(T3)、拔出气管导管时(T4)血流动力学[平均动脉压(MAP)和心率(HR)]、神经源炎性因子[神经生长因子(NGF)、前列腺素E_(2)(PGE_(2))、P物质和神经激肽A(NKA)]、脑保护作用指标[脑氧摄取率(CERO_(2))、动脉-颈内静脉球部血氧差(Da-jvO_(2))、神经元特异性烯醇化酶(NSE)和S-100β蛋白],术后第1、2、3天疼痛视觉模拟评分法(VAS)、术后恶心呕吐(PONV)评分,术前和术后第1、3、7天简明精神状态量表(MMSE)评分,苏醒质量,以及术中、术后不良反应。结果T2~T4时,2组MAP和HR均呈现升高趋势,NGF、PGE_(2)、SP、NKA、CERO_(2)、Da-jvO_(2)、NSE和S-100β蛋白均呈现降低趋势;且观察组MAP和HR均高于对照组,NGF、PGE_(2)、SP、NKA、CERO_(2)、Da-jvO_(2)、NSE和S-100β蛋白均低于对照组(P<0.05)。术后第1、2及3天,2组VAS和PONV评分均呈下降趋势,术后第1、3及7天MMSE评分均呈升高趋势;且观察组术后第1、2及3天VAS和PONV评分低于对照组,术后第1、3及7天MMSE评分高于对照组(P<0.05)。观察组拔管时间和苏醒时间均短于对照组,拔管后10 min Ramsay评分低于对照组(P<0.05)。术中和术后,观察组不良反应发生率为11.63%(5/43)低于对照组37.21%(16/43)(P<0.05)。结论艾司氯胺酮无阿片全身麻醉用于老年THR患者有利于稳定血流动力学,提高术后苏醒质量,缓解疼痛感,且能改善脑氧代谢,降低不良反应发生率,分析可能与其调节神经源炎症反应有关。

Objective To investigate the effects of opioid-free general anesthesia with Esketamine on neurogenic inflammatory factors,cerebral oxygen metabolism,anesthesia and recovery quality in elderly patients undergoing total hip replacement(THR).Methods A total of 86 elderly patients who received elective THR from April 2022 to April 2023 were randomly divided into observation group(n=43)and control group(n=43).The observation group received opioid-free anesthesia with Esketamine and the control group received conventional anesthesia.The hemodynamics[mean arterial pressure(MAP)and heart rate(HR)],neurogenic inflammatory factors[nerve growth factor(NGF),prostaglandin E_(2)(PGE_(2)),Substance P(SP)and neurokinin A(NKA)]and cerebral protection indicators[cerebral oxygen uptake rate(CERO_(2)),arterio-jugular bulbar hypoxia(Da-jvO_(2)),neuron-specific enolase(NSE)and S-100βprotein]of the two groups were compared before anesthesia induction,at endotracheal intubation(T2),at skin resection(T3),and at withdrawal of endotracheal catheter(T4).Visual analogue scale(VAS)pain score,postoperative nausea and vomiting(PONV)score at 1,2 and 3 d after surgery,Mini-Mental State Examination(MMSE)scores at 1,3,and 7 d after surgery,quality of recovery,and intraoperative and postoperative adverse reactions were compared between the two groups.Results At T2-T4,MAP and HR showed an increasing trend,while NGF,PGE_(2),SP,NKA,CERO_(2),Da-jvO_(2),NSE and S-100βshowed a decreasing trend.MAP and HR in observation group were higher than those in control group,while NGF,PGE_(2),SP,NKA,CERO_(2),Da-jvO_(2),NSE and S-100βprotein were lower than those in control group(P<0.05).At 1,2 and 3 d after operation,VAS and PONV scores of both groups showed a decreasing trend,while MMSE scores showed an increasing trend at 1,3,and 7 d after operation.VAS and PONV scores in observation group were lower than those in control group at 1,2 and 3 d after operation,while MMSE scores were higher than those in control group at 1,3,and 7 d after operation(P<0.05).The time to extubation and recovery time of observation group were shorter than those of control group,and the Ramsay score at 10 min after extubation was lower than that of control group(P<0.05).During and after operation,the incidence of adverse reactions in the observation group was 11.63%(5/43),which was lower than that in the control group[37.21%(16/43)](P<0.05).Conclusion Opioid-free general anesthesia with Esketamine is beneficial to stable hemodynamics,improve postoperative recovery quality,relieve pain in elderly patients with THR,improve cerebral oxygen metabolism,and reduce the incidence of adverse reactions,which may be related to the regulation of neurogenic inflammatory response.