老年患者髋关节周围骨折手术麻醉的优化策略:艾司氯胺酮联合髂筋膜间隙-蛛网膜下腔阻滞  

Optimization strategy of anesthesia in elderly patients undergoing hip fracture surgery:combination of esketamine and fascia iliaca compartment-subarachnoid block

作　　者：齐曼曼 李妍 张天鸽 高梦亚 孙文波[1] Qi Manman;Li Yan;Zhang Tiange;Gao Mengya;Sun Wenbo(Department of Anesthesiology,Cangzhou Central Hospital,Cangzhou 061000,China)

机构地区：[1]沧州市中心医院麻醉科,沧州061000

出　　处：《中华麻醉学杂志》2023年第6期728-731,共4页Chinese Journal of Anesthesiology

基　　金：沧州市科技重点研发计划项目(213106090)。

摘　　要：目的评价艾司氯胺酮联合髂筋膜间隙-蛛网膜下腔阻滞对老年患者髋关节周围骨折手术麻醉的优化效果。方法选择老年髋关节周围骨折行手术治疗的患者62例,年龄60~85岁,BMI 18.5~30.0 kg/m^(2),ASA分级Ⅱ或Ⅲ级,性别不限。采用随机数字表法将患者分为2组(n=31):髂筋膜间隙-蛛网膜下腔阻滞组(FS组)和艾司氯胺酮联合髂筋膜间隙-蛛网膜下腔阻滞组(ES组)。FS组患者在蛛网膜下腔麻醉操作前30 min术侧行超声引导下髂筋膜间隙阻滞;ES组患者在髂筋膜间隙-蛛网膜下腔阻滞的基础上,于切皮前5 min静脉注射艾司氯胺酮0.25 mg/kg。术后镇痛采用PCIA,若疼痛数字评分>4分,静脉注射曲马多1 mg/kg进行补救镇痛。记录术后48 h内镇痛泵按压次数、补救镇痛次数和曲马多消耗量;记录术后不良反应(呼吸抑制、恶心、呕吐、头晕、嗜睡、皮肤瘙痒、幻觉、噩梦)的发生情况。结果与FS组比较,ES组患者术后曲马多消耗量降低,镇痛泵按压次数和补救镇痛次数减少(P<0.05);2组患者术后不良反应发生率比较差异无统计学意义(P>0.05)。结论艾司氯胺酮联合髂筋膜间隙-蛛网膜下腔阻滞用于老年患者髋关节周围骨折手术可提高术后镇痛效果,优化临床管理策略。Objective To evaluate the efficacy of esketamine combined with fascia iliaca compartment-subarachnoid block in optimizing anesthesia in elderly patients undergoing hip fracture surgery.Methods Sixty-two American Society of Anesthesiologists Physical Status classificationⅡorⅢelderly patients of either sex,aged 60-85 yr,with body mass index of 18.5-30.0 kg/m^(2),were divided into 2 groups(n=31 each)using a random number table method:fascia iliaca compartment-subarachnoid block group(FS group)and esketamine combined with fascia iliaca compartment-subarachnoid block group(ES group).In FS group,patients underwent ultrasound-guided fascia iliaca compartment block at 30 min before the operation of subarachnoid anesthesia on the surgical side.In ES group,esketamine 0.25 mg/kg was intravenously administered at 5 min before skin incision based on the fascia iliaca compartment-subarachnoid block.Patient-controlled intravenous analgesia was used for postoperative analgesia,and tramadol 1 mg/kg was intravenously given for rescue analgesia when numerical rating scale score>4.The pressing times of patient-controlled analgesic pump,the number of rescue analgesia and consumption of tramadol were recorded within 48 h after operation.The occurrence of postoperative adverse reactions(respiratory depression,nausea and vomiting,dizziness,drowsiness,pruritus,illusion,nightmares)was recorded.Results Compared with FS group,the consumption of postoperative tramadol was significantly decreased,and the pressing times of patient-controlled analgesic pump and the number of rescue analgesia were reduced in ES group(P<0.05).There were no significant differences in the incidence of postoperative adverse reactions between the two groups(P>0.05).Conclusions Combination of esketamine with fascia iliaca compartment-subarachnoid block for hip fracture surgery can raise postoperative analgesia and optimize clinical management strategies in elderly patients.

关 键 词：老年人 髋关节 氯胺酮 髂骨 筋膜 蛛网膜下腔 神经传导阻滞 

分 类 号：R614[医药卫生—麻醉学]