艾司氯胺酮预处理对臂丛神经阻滞老年手术患者术后疼痛循环呼吸及炎症因子的影响  

Effcts of Esmketamine pretreatment on postoperative pain,circulatory and respiratory function and inflammatory factors in elderly patients w ith brachial plexus block

作　　者：孙艳[1] 霍文文 金晓菲[1] Sun Yan;Huo Wenwen;Jin Xiaofei(Department of Anesthesiology,the First Affiliated Hospital of Suzhou University,Suzhou 251006,China)

机构地区：[1]苏州大学附属第一医院麻醉科,苏州215006

出　　处：《中华老年医学杂志》2021年第12期1546-1550,共5页Chinese Journal of Geriatrics

基　　金：国家自然科学基金(BK20200195)。

摘　　要：目的分析艾司氯胺酮预处理对臂丛神经阻滞老年手术患者术后疼痛、循环呼吸及炎症因子的影响。方法前瞻性选取2020年1月至2021年4月入本院接受手术治疗的肩袖损伤患者98例, 按照随机数字法进行分组, 分为对照组和艾司氯胺酮预处理组, 每组49例, 艾司氯胺酮预处理组经静脉给予0.5 mg/kg的艾司氯胺酮, 对照组给予等量生理盐水、对比两者患者的一般资料、术后疼痛情况、循环呼吸功能、术后炎症因子水平以及不良反应情况。结果艾司氯胺酮预处理组术中30、60和90 min Ramsay镇静(RSS)评分较对照组相比无明显差异(均P>0.05), 艾司氯胺酮预处理组术后12 h、24 h的VAS评分低于对照组(均P<0.05), 两组VAS评分在不同的时间点存在组间、时间以及交互效应(均P<0.05);艾司氯胺酮预处理组在T1、T2、T3时的平均动脉压、心率、脉搏血氧饱和度和呼吸频率较对照组同时刻相比都明显降低(均P<0.05);术后24 h, 艾司氯胺酮预处理组中的白介素-6[(198.74±21.50)mmol/L和(272.69±19.74)mmol/L, t=17.537, P<0.001]、C反应蛋白[(11.65±2.51)mg/L和(15.79±3.27)mg/L, t=7.972, P<0.001]、肿瘤坏死因子-α[(25.71±10.27)ng/L和(34.65±9.81)ng/L, t=10.113, P<0.001]、β内啡肽[(1.69±0.27)ng/L和(2.18±0.35)ng/L, t=8.815, P<0.001]和神经元特异性烯醇化酶[(8.48±0.93)ng/L和(13.57±1.89)ng/L, t=9.846, P<0.001]水平明显低于对照组;艾司氯胺酮预处理组的不良反应总发生率低于对照组(16.3%和8.2%, χ^(2)=3.129, P=0.047)。结论艾司氯胺酮预处理臂丛神经阻滞老年手术能够提供良好的镇痛效果, 对循环呼吸影响较小, 能够有效降低炎症水平和不良反应的发生率。Objective To investigate the efects of Esmketamine pretreatment on postoperative pain,circulatory and respiratory function and inflammatory factors in elderly patients undergoing brachial plexus block.Methods A total of 98 patients with rotator cuff injuries admitted to our hospital from December 2019 to December 2020 were prospectively divided into the control group and the Esmketamine pretreatment group,with 49 cases in each group.The Esmketamine pretreatment group was given 0.5 mg/kg of Esmketamine intravenously,and the control group was given the same amount of normal saline intravenously.General data.postoperative pain,circulatory and respiratory function.postoperative inflammatory factor levels and adverse reactions were compared between the two groups.Results Intraoperative Ramsay sedation scores(RSS)at 30 min.60 min and 90 min had no significant difference between the Esmketamine pretreatment group and the control group(all P>0.05).Visual analogue scale(VAS)scores at 12 h and 24 h after surgery were lower in the Esmketamine pretreatment group than in the control group(all P<0.05).The VAS scores showed differences between the two groups at different time points(all P<0.05)and there were also signs of interaction efcts.The mean arterial pressure(MAP).heart rate(HR).oxyhaemoglobin saturation by pulse oximetry(SpO2)and respiratory rate(RR)at T1、T2 and T3 were lower in the ESM-ketamine pretreatment group than in the control group(all P<0.05).Compared with the control group,the Esmketamine pretreatment group had lower levels of interleukin 6(IL-6)[(198.74±21.50)mmol/L vs.(272.69±19.74)mmol/L.t=17.537,P<0.001],C-reactive protein(CRP)[(11.65±2.51)mg/L v8.(15.79±3.27)mg/L.t=7.972.P<0.001],tumor necrosis factor α(TNF-α)(25.71±10.27 ng/L vs.34.65±9.81 ng/L.t=10.113.P<0.001).β-endorphin[(1.69±0.27)ng/L vs.(2.18±0.35)ng/L.t=8.815.P<0.001]and neuron-specific enolase(NSE)[(8.48±0.93)ng/L vs.(13.57±1.89)ng/L.t=9.846.P<0.001]at 24 h after surgery.The total incidence of adverse reactions was also lower in th

关 键 词：氯胺酮 臂丛神经病 疼痛 炎症因子 

分 类 号：R614[医药卫生—麻醉学]