佐剂艾司氯胺酮行前路腰方肌阻滞对老年患者术后疼痛及认知功能的影响  

The effect of anterior lumbar square muscle block with adjuvant esketamine on postoperative pain and cognitive function in elderly patients

作　　者：刘明红 李菊[1] 陈慧春 张莉[1] 石军 LIU Ming-hong;LI ju;CHEN Hui-chun;ZHANG Li;SHI Jun(Department of Anesthesiology,The First Affiliated Hospital of Anhui University of Technology,Huainan 232000,Chian;Medical Laboratory,The First Affiliated Hospital of Anhui University of Technology,Huainan 232000,Chian)

机构地区：[1]安徽理工大学第一附属医院麻醉科,安徽淮南232000 [2]安徽理工大学第一附属医院检验科,安徽淮南232000

出　　处：《实用医院临床杂志》2023年第5期166-170,共5页Practical Journal of Clinical Medicine

基　　金：淮南市科技计划项目(编号:2020091);中国红十字基金会医学赋能公益专项基金(编号:2022446)。

摘　　要：目的 观察艾司氯胺酮复合盐酸罗哌卡因行前路腰方肌阻滞对老年患者髋关节置换术后疼痛、应激反应及认知功能的影响。方法 选择腰硬联合麻醉下行髋关节置换术的择期患者60例,采用随机数字法分为罗哌卡因组(L组)及艾司氯胺酮复合罗哌卡因组(AL组)各30例。两组术后镇痛均采用前路腰方肌阻滞,其中L组采用0.375%盐酸罗哌卡因20 ml;AL组采用艾司氯胺酮25 mg+0.375%盐酸罗哌卡因20 ml。记录两组患者在术后12 h(T_(1))、24 h(T_(2))及48 h(T_(3))时静息及运动的视觉模拟评分(VAS)、认知功能、氧化应激水平及不良反应发生率等。结果 与L组比较,在T_(1)时间点静息和运动状态下,AL组的VAS评分均更低(P<0.05);与L组比较,在T_(1)时间点AL组的简易智能状态量表(MMSE)评分更高,匹兹堡睡眠质量指数(PSQI)评分更低(P<0.05);超氧化物歧化酶高于L组,而丙二醛低于L组(P<0.05)。结论 小剂量艾司氯胺酮复合罗哌卡因进行前路腰方肌阻滞,术后早期镇痛效果好,应激反应轻,认知功能影响小,安全性好。Objective To observe the effect of anterior quadratus lumborum block with esketamine combined with ropivacaine hydrochloride on pain,stress response and cognitive function in elderly patients after hip replacement.Sixty patients with elective hip arthroplasty were selected.The patients were divided into a ropivacaine group(L group)and an esketamine combined with ropivacaine group(AL group)according to random number table method,30 in each group.Anterior quadratus lumborum block was used for postoperative analgesia in both groups,among which 0.375%ropivacaine hydrochloride 20ml was used in the L group and esketamine 25 mg+0.375%ropivacaine hydrochloride 20ml was used in the AL group.At 12 h(T_(1)),24 h(T_(2))and 48 h(T_(3))after operation,visual analogue score(VAS),cognitive function,oxidative stress level and incidence of adverse effects at rest and movement were recorded in both groups.Compared with the L group,the VAS scores were lower in the AL group at both rest and exercise at the T1 time point(P<0.05).The Mini-mental State Examination(MMSE)scores were higher in the AL group at the T_(1) time point when compared with the L group(P<0.05).Compared with the L group,the Pittsburgh sleep quality index(PSQI)scores were lower in the AL group at the T1 time point,and superoxide dismutase(SOD)was higher while malondialdehyde(MDA)was lower(P<0.05).Small-dose esketamine combined with ropivacaine for anterior quadratus lumborum block has good early postoperative analgesic effect,mild stress response and little impact on cognitive function.

关 键 词：艾司氯胺酮 腰方肌阻滞 认知功能 术后镇痛 

分 类 号：R614[医药卫生—麻醉学]