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| 小剂量艾司氯胺酮复合舒芬太尼术后镇痛对老年患者髋关节置换术后早期认知功能的影响 |
| Effects of low-dose esketamine combined with sufentanil postoperative analgesia on early cognitive function in elderly patients after hip arthroplasty |
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| DOI：10.12089/jca.2022.09.008 |
| 中文关键词: 艾司氯胺酮 患者自控静脉镇痛 人工髋关节置换术 术后认知功能障碍 |
| 英文关键词: Esketamine Patient-controlled intravenous analgesia Artificial hip replacement Postoperative cognitive dysfunction |
| 基金项目:江苏省社会发展重点研发项目-临床前沿技术（BE2021659） |
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| 中文摘要: |
目的 观察小剂量艾司氯胺酮复合舒芬太尼对老年髋关节置换患者术后疼痛及早期认知功能的影响。
方法 选择择期在腰-硬联合麻醉下行全髋关节置换术老年患者60例，男34例，女26例，年龄65～80岁，BMI 18.6～27.5 kg/m2，ASA Ⅱ或Ⅲ级。采用随机数字表法将患者分为两组：舒芬太尼静脉自控镇痛组（对照组）和艾司氯胺酮复合舒芬太尼静脉自控镇痛组（观察组），每组30例。对照组镇痛配方为舒芬太尼1.5 μg/kg+格拉司琼6 mg；观察组镇痛配方为艾司氯胺酮0.2 mg/kg+舒芬太尼1.3 μg/kg+格拉司琼6 mg。记录术后6、12、24、48、72 h的静息和活动时VAS疼痛评分。分别于术前1 d、术后24和72 h抽取静脉血3 ml，采用双抗夹心ELISA法检测血清TNF-α和IL-6浓度。记录术前1 d、术后3、7 d的MoCA评分，并统计术后7 d POCD的发生情况。
结果 观察组术后6、12、24、48、72 h活动时VAS疼痛评分及术后48、72 h时静息时VAS疼痛评分明显低于对照组（P<0.05），术后24、72 h的TNF-α、IL-6浓度明显低于对照组（P<0.05），术后3 d MoCA评分明显高于对照组（P<0.05）。观察组术后7 d有3例（10%）发生POCD，明显少于对照组的11例（37%）（P<0.05）。
结论 在老年患者髋关节置换术后采用小剂量艾司氯胺酮复合舒芬太尼镇痛，可以有效抑制炎性介质的释放，明显减轻患者术后疼痛，改善术后早期认知功能。 |
| 英文摘要: |
Objective To observe the effects of low-dose esketamine combined with sufentanid analgesia on postoperative pain and early cognitive function in elderly patients with hip replacement.
Methods Sixty elderly patients with elective total hip arthroplasty under combined spinal-epidural anesthesia, 34 males and 26 females, aged 65-80 years, BMI 18.6-27.5 kg/m2, ASA physical status Ⅱ or Ⅲ were selected and divided into two groups according to the random number table method: sufentanil intravenous patient-controlled analgesia group (control group) and esketamine combined with sufentanil intravenous patient-controlled analgesia group (observation group), 30 patients in each group. The analgesic formula of the control group was sufentanil 1.5 μg/kg plus granisetron 6 mg; the analgesic formula of the observation group was esketamine 0.2 mg/kg plus sufentanil 1.3 μg/kg plus granisetron 6 mg. The resting and activity visual analogue scale (VAS) scores of the two groups of patients were recorded at 6, 12, 24, 48, 72 hours after operation. The MoCA scores were recorded 1 day before surgery, 3 days after surgery, and 7 days after surgery. 3 ml of venous blood was drawn 1 day before surgery, 24 and 72 hours after surgery, respectively, and the serum TNF-α and IL-6 concentrations were detected by double-antibody sandwich ELISA.
Results The active VAS score at 6, 12, 24, 48, and 72 hours after operation, the resting VAS score at 48 and 72 hours after operation in the observation group were significantly lower than those in the control group (P < 0.05). The levels of TNF-α and IL-6 at 24 and 72 hours after the operation were significantly lower than those in the control group (P < 0.05). The MoCA score of the observation group was significantly higher than that of the control group 3 days after operation (P < 0.05). In the observation group, 3 cases (10%) developed POCD 7 days after operation, and 11 cases (37%) in the control group developed POCD (P < 0.05).
Conclusion The use of low-dose esketamine combined with sufentanil for analgesia after hip replacement in elderly patients can effectively inhibit the release of inflammatory mediators, significantly reduce postoperative pain, and improve postoperative cognitive function of patients. |
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