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| 艾司氯胺酮与右美托咪定在中老年患者全髋关节置换术中的比较 |
| Comparison of esketamine and dexmedetomidine in middle-aged and elderly patients undergoing total hip arthroplasty |
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| DOI：10.12089/jca.2023.02.010 |
| 中文关键词: 艾司氯胺酮 右美托咪定 全髋关节置换术 老年 |
| 英文关键词: Esketamine Dexmedetomidine Total hip arthroplasty Aged |
| 基金项目: |
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| 中文摘要: |
目的 比较艾司氯胺酮与右美托咪定在中老年患者全髋关节置换术中的应用效果。
方法 选择择期行单侧全髋关节置换术的中老年患者60例，男17例，女43例，年龄60～80岁，BMI 18～28 kg/m2，ASA Ⅱ或Ⅲ级。将患者随机分为两组：右美托咪定组（D组，n=30）和艾司氯胺酮组（S组，n=30）。选择L2-3间隙行腰-硬联合麻醉（CSEA），维持平面T6—T10。D组：静脉注射咪达唑仑0.04 mg/kg，5 min后静脉注射右美托咪定0.25 μg/kg，后维持0.2～0.7 μg·kg-1·h-1。S组：静脉注射咪达唑仑0.04 mg/kg，5 min后静脉注射艾司氯胺酮0.35 mg/kg，后维持0.3～0.4 mg·kg-1·h-1。记录入室时、椎管内麻醉10 min后、静注咪达唑仑后10、30、60 min的HR和MAP。记录术中血管活性药物使用情况。记录静注咪达唑仑30、90 min以及开始缝皮时的Ramsay镇静评分。记录术中及术后不良反应的发生情况。
结果 与D组比较，静注咪达唑仑后30、60 min，S组HR明显增快（P＜0.05），术中麻黄碱、阿托品、去甲肾上腺素的使用率明显降低（P＜0.05）。两组不同时点Ramsay镇静评分、术中及术后不良反应发生率差异均无统计学意义。
结论 艾司氯胺酮与右美托咪定均可安全有效地应用于中老年患者全髋关节置换术，但艾司氯胺酮术中血流动力学更加稳定，且不增加不良反应的发生。 |
| 英文摘要: |
Objective To compare the effect of esketamine and dexmedetomidine in middle-aged and elderly patients undergoing total hip arthroplasty.
Methods Sixty patients who underwent elective unilateral total hip arthroplasty were selected, 17 males and 43 females, aged 60-80 years, BMI 18-28 kg/m2, ASA physical status Ⅱ or Ⅲ. All the patients were randomly divided into two groups: dexmedetomidine group (group D, n = 30) and esketamine group (group S, n = 30). L2-3 intervertebral space was chosen to be punctured in CSEA and the anesthesia plane was adjusted at T6-T10. Group D intravenously received injection of midazolam 0.04 mg/kg. After 5 minutes, dexmedetomidine 0.25 μg/kg was injected, and then the dose of dexmedetomidine was maintained at 0.2-0.7 μg·kg-1·h-1 intravenously. While in group S, midazolam 0.04 mg/kg was intravenously injected. After 5 minutes, esketamine 0.35 mg/kg was injected, and then the dose of esketamine was maintained at 0.3-0.4 mg·kg-1·h-1 intravenously. HR and MAP were recorded upon entering the room, 10 minutes after spinal anesthesia, 10 minutes, 30 minutes, 60 minutes after administration of midazolam. The use of vasoactive drugs during the operation was recorded. The sedation status (Ramsay sedation score) 30, 90 minutes after administration of midazolam and the beginning of skin suture were recorded. The incidence of intraoperative and postoperative adverse reactions was recorded.
Results Compared with group D, HR was significantly higher in group S 30, 60 minutes after administration of midazolam (P < 0.05), the intraoperative usage of ephedrine, atropine and norepinephrine was significantly less in group S (P < 0.05). There were no significant differences in Ramsay sedation score at different time points, intraoperative and postoperative adverse reactions between the two groups.
Conclusion Esketamine and dexmedetomidine both can be safely and effectively used in total hip arthroplasty of middle-aged and elderly patients, but esketamine can provide more stable hemodynamics without increasing adverse reactions. |
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