转化医学杂志2023，Vol.12Issue(6)：350-356,7.DOI:10.3969/j.issn.2095-3097.2023.06.010
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 Re-covery Quality in Elderly Patients Undergoing Total Hip Arthroplasty
摘要
Abstract
Objective To investigate the effects of opioid-free general anesthesia with Esketamine on neurogenic in-flammatory factors,cerebral oxygen metabolism,anesthesia and recovery quality in elderly patients undergoing total hip re-placement(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 an-esthesia 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 E2(PGE2),Substance P(SP)and neurokinin A(NKA)]and cerebral protection indicators[cerebral oxygen uptake rate(CERO2),ar-terio-jugular bulbar hypoxia(Da-jvO2),neuron-specific enolase(NSE)and S-100β protein]of the two groups were com-pared 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 intraop-erative and postoperative adverse reactions were compared between the two groups.Results At T2-T4,MAP and HR showed an increasing trend,while NGF,PGE2,SP,NKA,CERO2,Da-jvO2,NSE and S-100β showed a decreasing trend.MAP and HR in observation group were higher than those in control group,while NGF,PGE2,SP,NKA,CERO2,Da-jvO2,NSE and S-100β protein 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 recov-ery 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 quali-ty,relieve pain in elderly patients with THR,improve cerebral oxygen metabolism,and reduce the incidence of adverse reac-tions,which may be related to the regulation of neurogenic inflammatory response.关键词
关节成形术,置换,髋/老年人/艾司氯胺酮/无阿片麻醉/平均动脉压/神经生长因子/脑氧摄取率/疼痛视觉模拟评分法Key words
Arthroplasty,replacement,hip/Elderly/Esketamine/Non-opioid Anesthesia/Mean arterial pressure/Nerve growth factor/Cerebral oxygen uptake rate/Visual analogue scale of pain分类
医药卫生引用本文复制引用
徐同生,孙卫楠,陈晓东,王猛..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[J].转化医学杂志,2023,12(6):350-356,7.基金项目
无锡市卫生健康委科研项目(Z202218) （Z202218）
