中国现代医学杂志2025，Vol.35Issue(5)：1-6,6.DOI:10.3969/j.issn.1005-8982.2025.05.001
艾司氯胺酮联合腰丛-坐骨神经阻滞对老年股骨颈骨折术后疼痛应激及认知功能的影响
Effect of esketamine combined with lumbar plexus-sciatic nerve block on postoperative pain stress and cognitive function in elderly patients with femoral neck fractures
摘要
Abstract
Objective To evaluate the effect of esketamine combined with lumbar plexus-sciatic nerve block on postoperative pain stress and cognitive function in elderly patients with femoral neck fractures.Methods Ninety-four elderly patients with femoral neck fractures scheduled for open reduction and internal fixation at Xiaolan People's Hospital from May 2023 to December 2023 were enrolled and randomly divided into the esketamine group(n=47)and saline group(n=47).Prior to nerve block,the esketamine group received intravenous(Ⅳ)0.2 mg/kg esketamine over 10 minutes,followed by continuous infusion at 0.5 mg/(kg·h)until surgery completion.The saline group received Ⅳ 10 mL saline over 10 minutes,followed by equivalent volume and rate saline infusion.Outcomes included block completion time,onset time,and regression time;heart rate(HR)and mean arterial pressure(MAP)at baseline(T0),10 min(T1),20 min(T2),30 min(T3)after block,skin incision(T4),30 min intraoperatively(T5),and surgery end(T6);substance P(SP)and prostaglandin E2(PGE2)levels at T0,postoperative day 1(T7),day 3(T8),and day 7(T9);Mini-Mental State Examination(MMSE)scores at T0,T7,T8,and T9.Results No intergroup difference was observed in block completion time(P＞0.05).The esketamine group exhibited shorter block onset time and longer regression time versus the saline group(P＜0.05).HR and MAP analysis revealed:(1)No significant difference in MAP across time points(P＞0.05),but HR varied significantly(P＜0.05);(2)Intergroup MAP differed significantly(P＜0.05),with lower and more stable MAP in the esketamine group;(3)MAP trends differed significantly(P＜0.05),while HR trends did not(P＞0.05).SP,PGE2,and MMSE analysis showed:(1)Significant temporal variations in SP,PGE2,and MMSE(all P＜0.05);(2)Significant intergroup differences(P＜0.05),with lower SP/PGE2 levels,higher MMSE scores,and superior analgesia in the esketamine group;(3)Significant intergroup trends(all P＜0.05).Conclusion Esketamine combined with lumbar plexus-sciatic nerve block in elderly femoral neck fracture surgery achieves rapid block onset,prolonged duration,hemodynamic stability,reduced postoperative pain stress,and preserved cognitive function.关键词
股骨颈骨折/艾司氯胺酮/腰丛-坐骨神经阻滞/疼痛应激/认知功能Key words
femoral neck fracture/esketamine/lumbar plexus-sciatic nerve block/pain stress/cognitive function分类
医药卫生引用本文复制引用
李欢,王立勋,扶晟,胡家祺..艾司氯胺酮联合腰丛-坐骨神经阻滞对老年股骨颈骨折术后疼痛应激及认知功能的影响[J].中国现代医学杂志,2025,35(5):1-6,6.基金项目
广东省自然科学基金(No:2021A1515010077) （No:2021A1515010077）
