摘要
目的观察艾司氯胺酮对老年腰椎开放手术患者围术期镇痛和应激反应的影响。方法选取2023年8—12月临沂市中心医院拟于全身麻醉下行腰椎开放手术的老年患者60例,采用随机数字表法分为观察组和对照组,每组30例。观察组在切皮前给予盐酸艾司氯胺酮注射液静脉推注,手术开始后持续泵注盐酸艾司氯胺酮注射液,对照组则在术前和术中给予同等剂量的生理盐水,2组均于手术结束时停止泵注。比较2组患者麻醉前(T_(0))与苏醒后30 min(T_(1))、2 h(T_(2))、4 h(T_(3))、8 h(T_(4))、12 h(T_(5))、24 h(T_(6))时视觉模拟评分法(VAS)评分,围术期阿片类药物使用量、术后24 h内静脉镇痛泵按压次数,T_(0)~T_(6)时血浆皮质醇(Cor)、肾上腺素(E)水平及术后不良反应。结果T_(0)、T_(6)时,2组VAS评分比较差异无统计学意义(P>0.05);T_(1)~T_(5)时,观察组VAS评分均低于对照组(P<0.01)。观察组瑞芬太尼、舒芬太尼用量与术后24 h内静脉镇痛泵按压次数均少于对照组(P<0.01)。与T_(0)时相比,2组T_(1)~T_(6)时血浆Cor、E水平出现不同程度降低,且T_(1)~T_(5)时观察组血浆Cor、E水平低于对照组(P<0.05或P<0.01),T_(6)时2组血浆Cor、E水平比较,差异无统计学意义(P>0.05)。观察组术后恶心、呕吐发生率均低于对照组(6.7%vs.26.7%、3.3%vs.26.7%,χ^(2)/P=4.320/0.038、4.706/0.030),2组术后皮肤瘙痒、嗜睡、呼吸抑制和谵妄发生率比较,差异均无统计学意义(P>0.05)。结论艾司氯胺酮应用于老年腰椎开放手术患者可有效缓解术后创面疼痛,减少患者应用阿片类镇痛药物的用量,抑制机体的创伤应激反应,并可降低术后恶心、呕吐发生率。
Objective To evaluate the effect of esketamine on peri-operative analgesia and stress response in elderly patients undergoing open lumbar spine surgery.Methods Sixty cases of elderly patients admitted to Linyi Central Hospital from August to December 2023 who were proposed to undergo open lumbar spine surgery under general anesthesia were selected,and they were divided into the observation group and the control group using the random number table method,with 30 cases in each group.The observation group was given an intravenous push of esketamine hydrochloride injection before skin cutting and continuous pumping of esketamine hydrochloride injection after the start of surgery.The control group was given the same dose of physiological saline before and during surgery.Pumping were stopped at the end of surgery in the two groups.VAS scores at T_(0)to T_(6),amount of opioid use during the peri-operative period,number of intravenous analgesic pump presses in the 24 h postoperative period,levels of Cor,E at T_(0)to T_(6),and postoperative adverse reactions were compared between the two groups.Results At T_(0)and T_(6),there was no statistically significant difference in the comparison of VAS scores between the two groups(P>0.05);At T_(1)to T_(5),VAS scores of the observation group were lower than those of the control group(P<0.01).The usage amounts of remifentanil and sufentanil,as well as the number of presses on the intravenous PCA pump within 24 h after surgery were significantly lower in the observation group than those in the control group(P<0.01).Compared with that at T_(0),plasma levels of Cor and E in the two groups showed different degrees of reduction from T_(1)to T_(6),plasma levels of Cor and E in the observation group were lower than those of the control group from T_(1)to T_(5)(P<0.05 or P<0.01),and plasma levels of Cor and E in the two groups were not statistically significant when compared with those of the control group at T_(6)(P>0.05).The incidence of postoperative nausea and vomiting in the observation group were lower than those in the control group(6.7%vs.26.7%,3.3%vs.26.7%,χ^(2)/P=4.320/0.038,4.706/0.030).There were no statistically significant difference in the incidence of postoperative skin itching,drowsiness,respiratory depression,and delirium between the two groups(P>0.05).Conclusion The application of esketamine in elderly patients undergoing open lumbar spine surgery can effectively relieve postoperative traumatic pain,reduce the amount of opioid analgesic drugs applied by patients,inhibit the body′s traumatic stress response,and reduce the incidence of postoperative nausea and vomiting.
作者
陈本法
王成伟
李志冰
马玉峰
李玉见
邱彦明
张世杰
CHEN Benfa;WANG Chengwei;LI Zhibing;MA Yufeng;LI Yujian;QIU Yanming;ZHANG Shijie(Linyi Central Hospital,Shandong Province,Linyi 276400,China)
出处
《临床合理用药》
2025年第15期22-25,30,共5页
Chinese Journal of Clinical Rational Drug Use
基金
山东省医学会临床科研专项资金项目(YXH2022ZX4248)
吴阶平医学基金会临床科研专项资助基金项目(320.6750.2024-15-33)。
关键词
腰椎开放手术
老年人
艾司氯胺酮
围术期
镇痛
应激反应
Open lumbar spine surgery
Elderly
Esketamine
Peri-operative period
Analgesia
Stress response
