术中泵注S⁃氯胺酮对创伤性四肢长骨骨折切开复位内固定患者术后睡眠障碍的改善作用

Effectiveness of intraoperative S‑ketamine infusion in alleviating postoperative sleep disorders of patients during open reduction and internal fixation for traumatic long bone fractures

目的探讨术中泵注S⁃氯胺酮对创伤性四肢长骨骨折切开复位内固定患者术后睡眠障碍的改善作用。方法采用前瞻性随机对照研究分析2022年10月至2023年4月中国人民解放军南部战区总医院收治的84例创伤性四肢长骨骨折患者的资料。按随机数字表法将患者分为S⁃氯胺酮组和生理盐水组,均择期行切开复位内固定术。术前和术后24、48、72 h比较两组匹兹堡睡眠质量指数(PSQI)评分和医院焦虑和抑郁量表(HADS)评分。术前和术后3、6、12、24、48、72 h比较两组视觉模拟评分(VAS)。同时记录患者术后摁压阵痛泵次数和不良反应情况,如恶心、呕吐、致幻、噩梦等。结果共纳入创伤性四肢长骨骨折患者男60例,女24例;年龄18~65岁[36.5(25.5,54.8)岁]。S⁃氯胺酮组42例,术中静脉泵注0.5 mg·kg^(⁃1)·h^(⁃1) S⁃氯胺酮至术毕;生理盐水组42例,术中静脉泵注等剂量生理盐水至术毕。患者均获随访4~9 d[6.0(5.0,7.0)d]。术前两组PSQI评分差异无统计学意义(P>0.05);术后24、48、72 h S⁃氯胺酮组PSQI评分分别为7.5(7.0,9.0)分、4.0(3.0,5.3)分、1.0(1.0,2.0)分,均显著低于生理盐水组的10.0(8.0,12.0)分、7.0(5.0,8.0)分、2.0(1.0,3.0)分(P<0.05或0.01)。术前和术后48、72 h两组HADS评分差异均无统计学意义(P>0.05);术后24 h S⁃氯胺酮组HADS评分为2.0(0.0,3.0)分,显著低于生理盐水组的3.0(2.0,5.0)分(P<0.01)。术前和术后6、12、72 h两组VAS差异均无统计学意义(P>0.05);术后3、24、48 h S⁃氯胺酮组VAS分别为3.0(2.0,4.0)分、2.3(2.0,3.0)分、2.0(1.0,3.0)分,均低于生理盐水组的4.0(2.8,5.0)分、3.0(2.5,4.0)分、3.0(2.0,3.7)分(P<0.05)。两组术后摁压阵痛泵次数、恶心和呕吐发生率差异均无统计学意义(P>0.05)。此外,S⁃氯胺酮组2例出现苏醒后短暂性致幻,1例诉术中噩梦,返回病房后3例均未见任何异常。结论对于创伤性四肢长骨骨折切开复位内固定患者,术中泵注S⁃氯胺酮可显著改善术后睡眠障碍,同时缓解焦虑抑郁情绪及疼痛。

Objective To investigate the effectivensess of intraoperative S⁃ketamine infusion in alleviating postoperative sleep disorders of patients during open reduction and internal fixation for traumatic long bone fractures.Methods A prospective randomized controlled study was conducted to analyze the clinical data of 84 patients with traumatic long bone fracture admitted to General Hospital of Southern Theatre Command of PLA from October 2022 to April 2023.The patients undergone selective open reduction and internal fixation were divided into S⁃ketamine group and saline group according to the random number table.Pittsburgh sleep quality index(PSQI)scores and hospital anxiety and depression scale(HADS)scores were compared between the two groups before surgery,at 24,48,and 72 hours after surgery.Visual analogue scale(VAS)scores were compared between the two groups before,at 3,6,12,24,48,and 72 hours after surgery.The number of times the patients pressed the pump of patient⁃controlled intravenous analgesia postoperatively and adverse reactions such as nausea,vomiting,hallucinations or nightmares were recorded.Results A total of 60 male and 24 female patients with traumatic long bone fracture were included,aged 18⁃65 years[36.5(25.5,54.8)years].The S⁃ketamine group(n=42)received intravenous infusion of S⁃ketamine at a rate of 0.5 mg·kg^(⁃1)·h^(⁃1) until the end of surgery,while the saline group(n=42)received intravenous infusion of saline of the same volume until the end of surgery.All the patients were followed up for 4⁃9 days[6.0(5.0,7.0)days].No significant differences in PSQI scores were found between the two groups before surgery(P>0.05),while PSQI scores at 24,48,and 72 hours after surgery were 7.5(7.0,9.0)points,4.0(3.0,5.3)points,and 1.0(1.0,2.0)points respectively in the S⁃ketamine group,significantly lower than those in the saline group[10.0(8.0,12.0)points,7.0(5.0,8.0)points,and 2.0(1.0,3.0)points](P<0.05 or 0.01).There were no significant differences in HADS scores between the two groups before surgery and at 48 and 72 hours after surgery(P>0.05),while HADS score at 24 hours after surgery in the S⁃ketamine group was 2.0(0.0,3.0)points,significantly lower than that in the saline group[3.0(2.0,5.0)points](P<0.01).There were no significant differences in VAS scores between the two groups before,at 6,12,and 72 hours after surgery(P>0.05),while the VAS scores at 3,24,and 48 hours after surgery in the S⁃ketamine group were 3.0(2.0,4.0)points,2.3(2.0,3.0)points,and 2.0(1.0,3.0)points respectively,significantly lower than those in the saline group[4.0(2.8,5.0)points,3.0(2.5,4.0)points,and 3.0(2.0,3.7)points](P<0.05).There were no significant differences in the number of times the patients pressed the pump of patient⁃controlled intravenous analgesia postoperatively and the incidence of nausea and vomiting between the two groups(P>0.05).In the S⁃ketamine group,transient hallucination upon awakening was found in 2 patients and intraoperative nightmare in 1,who showed no abnormalities after returning to the ward.Conclusion Intraoperative S⁃ketamine infusion can significantly alleviate postoperative sleep disorders of patients during open reduction and internal fixation for traumatic long bone fractures,with simultaneous alleviation of anxiety,depression as well as pain.