摘要
目的:探讨艾司氯氨酮联合瑞马唑仑对髋关节置换术患者术后视觉模拟评分(Visual analogue scale,VAS)及T淋巴细胞亚群水平的影响。方法:选取2022年6月至2024年7月我院拟行髋关节置换术患者96例,以随机信封法分为P组和R组(n=48),分别在静脉泵注艾司氯胺酮0.05-0.1 mg·(kg·h)^(-1)的基础上联合丙泊酚0.5 mg·kg^(-1)及瑞马唑仑0.05 mg·kg-1进行麻醉。采用VAS评分、Ramsay评分评估术后6 h、12 h、24 h的疼痛及躁动程度,采用病人监护仪监测两组入室时(T1)、平面固定后(T2)、麻醉后15 min(T3)、30 min(T4)、60 min(T5)的心率、收缩压、舒张压,采用流式细胞仪检测患者术前、术后1 d、3 d、6 d的T淋巴细胞亚群水平(CD3^(+)、CD4^(+)、CD8^(+)),并分析比较两组术后不良反应发生情况。结果:两组术后6 h、12 h、24 h的VAS、Ramsay评分比较无明显差异(P>0.05)。R组T2-T5的心率、收缩压、舒张压波动幅度小于P组(P<0.05)。两组术后1 d、术后3 d的CD4+均降低,CD8+均升高,但R组CD4+降低幅度及CD8+升高幅度均小于P组(P<0.05)。两组术后不良反应比较无明显差异(P>0.05)。结论:艾司氯胺酮联合瑞马唑仑可减轻髋关节置换术患者术后疼痛及躁动程度,维持血流动力学及免疫功能的稳定。
Objective:To investigate the effects of Esketamine combined with remimazolan on postoperative Visual analogue scale(VAS)scores and T lymphocyte subsets in patients undergoing hip replacement surgery.Methods:A total of 96 patients who are scheduled to undergo hip replacement surgery in our hospital from June 2022 to July 2024 were selected.The patients were randomly divided into group P and group R(n=48)using the random envelope method.They were anesthetized with propofol 0.5 mg·kg^(-1) and remimazolan 0.05 mg·kg^(-1) in combination with intravenous pumping of esketamine 0.05·0.1 mg·(kg·hour)^(-1),respectively.VAS and Ramsay scores were used to assess the degree of pain and restlessness at 6,12,and 24 hours after surgery.The heart rate,systolic blood pressure,and diastolic blood pressure were monitored using a patient monitor at the time of entering the room(T1),after plane fixation(T2),15 minutes(T3),30 minutes(T4),and 60 minutes(T5)after anesthesia.The levels of T lymphocyte subsets(CD3^(+),CD4^(+),CD8^(+))were detected by flow cytometry before,and 1,3,and 6 days after surgery.The incidence of adverse reactions was analyzed and compared to the two groups after surgery.Results:There was no significant difference in VAS and Ramsay scores between the two groups at 6,12,and 24 hours after surgery(P>0.05).The fluctuation amplitude of heart rate,systolic pressure,and diastolic pressure during T2-T5 in group R was smaller than that in group P(P<0.05).CD4+was decreased and CD8+was increased in both groups on postoperative day 1 and day 3,but the decrease in CD4+in group R was less than that in group P,and the increase in CD8+was less than that in group P(P<0.05).There was no significant difference in adverse reactions between the two groups after surgery(P>0.05).Conclusion:The combination of esketamine and remimazolan can reduce postoperative pain and agitation in patients undergoing hip replacement surgery,and maintain stable hemodynamic and immune function.
作者
孙伟峰
于飞洋
范怡明
Sun Wei-feng;Yu Fei-yang;Fan Yi-ming(Department of Anesthesiology,The First Affiliated Hospital of Zhengzhou University,Zhengzhou 450000,China)
基金
河南省医学科技攻关计划联合共建项目(编号:LHGJ20201080)。
