临床误诊误治2025，Vol.38Issue(17)：80-84,5.DOI:10.3969/j.issn.1002-3429.2025.17.017
亚剂量艾司氯胺酮复合右美托咪定全身麻醉对老年下肢骨折手术患者麻醉效果及术后认知功能的影响
Effect of general anesthesia with sub-dose Esketamine combined with Dexmedetomidine on the anesthetic effect and postoperative cognitive function of elderly patients undergoing lower limb fracture surgery
摘要
Abstract
Objective To investigate the effect of sub-dose Esketamine combined with Dexmedetomidine on anesthesia and postoperative cognitive function in elderly patients undergoing lower limb fracture surgery.Methods A total of 80 elderly patients undergoing lower limb fracture surgery after admission from January 2023 to August 2024 were selected and divided into the observation group(n=40)and the control group(n=40)by random number table method.The observation group was given general anesthesia with sub-dose Esketamine combined with Dexmedetomidine,while the control group was given general anesthesia with Sufentanil combined with Dexmedetomidine.The changes of vital signs,analgesic score,sedation score,cognitive function score at different time points and adverse reactions were compared between the two groups.Results The mean arterial pressure(MAP)and heart rate(HR)in the observation group were lower than those in the control group at the time of skin incision,at 10 min after the initiation of operation and at the end of operation(P<0.05),while there was no significant difference in the blood oxygen saturation(SpO2)(P>0.05).The MAP and HR of the two groups showed a slow upward trend at the time of skin incision,at 10 min after the initiation of operation and at the end of operation,as compared with that at the time of entering the operating room(P<0.05),while there was no significant difference in SpO2 at the time of entering the operating room between the two groups(P>0.05).The visual analogue scale(VAS)pain scores of the observation group were lower than those of the control group at 6,12 and 24 h after operation(P<0.05),and the VAS pain scores of the two groups showed a decreasing trend with time(P<0.05).The Ramsay sedation score of the observation group was higher than that of the control group at 3 h after operation(P<0.05),and the Ramsay sedation score of the two groups decreased gradually with time(P<0.05).The scores of Montreal Cognitive Assessment(MoCA)and Mini-Mental State Examination(MMSE)in the observation group were higher than those in the control group at 12,24 and 48 h after operation(P<0.05),and the MoCA and MMSE scores of the two groups decreased first and then increased gradually with time(P<0.05).There was no significant difference in the incidence of respiratory depression,arrhythmia,abnormal blood pressure,nausea and vomiting between the two groups(P>0.05).Conclusion General Anesthesia with sub-dose Esketamine combined with Dexmedetomidine can meet the sedation needs of elderly patients undergoing lower limb fracture surgery,effectively improve the intraoperative circulatory stability and early postoperative cognitive function,and has no respiratory inhibition,which can ensure the safety of clinical anesthesia.关键词
下肢骨折/老年人/亚剂量/艾司氯胺酮/右美托咪定/麻醉/术后认知功能障碍Key words
lower limb fracture/elderly/sub-dose/Esketamine/Dexmedetomidine/anesthesia/postoperative cognitive dysfunction引用本文复制引用
杨燕,刘英,侯建平,黄刚,黄其杰,何天平..亚剂量艾司氯胺酮复合右美托咪定全身麻醉对老年下肢骨折手术患者麻醉效果及术后认知功能的影响[J].临床误诊误治,2025,38(17):80-84,5.基金项目
四川省国际医学交流促进会科研项目(L20230410007) （L20230410007）
