不同负荷量艾司氯胺酮联合腰麻对老年髋关节置换病人术后认知功能的影响  被引量:15

Effects of different loadings of S-ketamine combined with spinal anesthesia on the cognitive function of elderly patients undergoing hip arthroplasty

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作  者:陶李 孟杰 肖航 TAO Li;MENG Jie;XIAO Hang(Department of Anesthesiology fXiaogan Central Hospital,Hubei,Xiaogan 432000,China)

机构地区:[1]锦州医科大学孝感市中心医院研究生培养基地(湖北省孝感市中心医院)麻醉科,432000

出  处:《临床外科杂志》2022年第6期532-534,共3页Journal of Clinical Surgery

基  金:临床科研与培训专项(Z098001);孝感市科技计划项目(XGKJ2020010009)。

摘  要:目的评价不同负荷量艾司氯胺酮对老年髋关节置换病人术后认知功能障碍的影响。方法本研究为前瞻性病例对照研究。2020年9月~2021年9月行髋关节置换术的病人120例,采用随机数字表法分为三组,低负荷量艾司氯胺酮组(L组)40例,使用低负荷量艾司氯胺酮0.3 mg/kg,高负荷量艾司氯胺酮组(H组)40例,高负荷量艾司氯胺酮0.5 mg/kg,对照组(C组)40例。麻醉平面稳定后各组分别予以相应剂量药物静脉推注。手术开始时L组和H组均予以每小时0.1 mg/kg艾司氯胺酮泵注,C组予以每小时0.1 ml/kg的生理盐水泵注,至手术结束。评估病人术前及术后的简易智力状态检查量表(MMSE)评分,术后3分钟谵妄诊断量表(3D-CAM)评分、睡眠评分,术中病人的镇静程度评估表(RASS)评分和ICU非语言交流病人疼痛评估量表(COPT)评分,评估病人POCD的发生情况。结果与C组比较,L组和H组的POCD发生率及术后24 h的镇痛评分均降低,差异有统计学意义(P<0.05)。C组发生POCD13例,L组5例,H组4例,C组镇痛评分为(3.15±0.81)分,L组为(2.1±0.96)分,H组为(1.9±0.96)分,差异有统计学意义(P<0.05);H组不良反应的发生率(13例)高于C组(5例)和L组(3例)(P<0.05)。结论在老年髋关节置换术病人中应用小剂量艾司氯胺酮,可改善病人的术后认知情况,减少术后并发症的发生。Objective To evaluate the effects of different loading doses of S-ketamine on postoperative cognitive dysfunction in elderly patients with hip replacement.Methods This was a prospective case-control study.120 patients who underwent hip replacement surgery from September 2020 to September 2021 were randomly divided into three groups(n=40)by random number table method:low-load dose S-ketamine(group L,0.3 mg/kg),high-load dose of S-ketamine(group H,0.5 mg/kg)and control group(group C),After the level of anesthesia was stabilized,each group was given intravenous injection of corresponding doses of drugs.At the beginning of operation,both group L and group H were given 0.1 mg/(kgoh)S-ketamine by pump,and group C was given 0.1 ml/(kgoh)normal saline pump until the end of the operation.To evaluate the patients’preoperative and postoperative Mini-mental Status Examination(MMSE)scores,postoperative 3-minute Delirium Diagnostic Scale(3 D-CAM)scores,sleep scores,intraoperative sedation assessment scale(RASS)scores and ICU non-verbal communication patient pain assessment scale(COPT)score,assess patients for the occurrence of POCD.Results Compared with group C,the incidence of POCD and the analgesia score at 24 hours after operation were decreased in groups L and H(P<0.05).The incidence of POCD:13 cases in group C,5 cases in group L,and 4 cases in group H,analgesia scores:group C(3.15±0.81),group L(2.1±0.96),group H(1.9±0.96)(P<0.05);the incidence of adverse reactions in group H(13 cases)was higher than group C(5 cases)and group L(3 cases)(P<0.05).Conclusion The application of low-dose S-ketamine in elderly hip replacement patients can improve there postoperative cognitive cognition,reduce the occurrence of postoperative complications.

关 键 词:艾司氯胺酮 术后认知功能障碍 术后谵妄 髋关节置换术 神经炎症 

分 类 号:R614[医药卫生—麻醉学]

 

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