氟比洛芬酯联合艾司氯胺酮对髋关节置换术老年患者术后镇痛效果的临床研究  

Clinical trial of flurbiprofen axetil combined with esketamine in the treatment of elderly patients with undergoing hip arthroplasty

作　　者：陈晓林[1] 张沛重[1] 徐国亭[1] 李海中[1] CHEN Xiao-lin;ZHANG Pei-zhong;XU Guo-ting;LI Hai-zhong(Department of Anesthesia and Perioperative Medicine,The First Affliated Hospital of Nanyang Medical College,Nanyang 473000,Henan Province,China)

机构地区：[1]南阳医学高等专科学校第一附属医院麻醉与围术期医学科,河南南阳473000

出　　处：《中国临床药理学杂志》2023年第19期2766-2770,共5页The Chinese Journal of Clinical Pharmacology

摘　　要：目的观察氟比洛芬酯联合艾司氯胺酮超前镇痛对髋关节置换术老年患者术后镇痛效果。方法将有髋关节置换术指征并接受手术治疗的老年患者随机分为氟比洛芬酯组、艾司氯胺酮组、联合镇痛组和对照组。所有患者于手术正式结束前30 min停止使用维持麻醉药物,氟比洛芬酯组给予0.65 mg·kg^(-1)氟比洛芬酯;艾司氯胺酮组给予0.35 mg·kg^(-1)艾司氯胺酮;联合镇痛组给予0.35 mg·kg^(-1)氟比洛芬酯+0.25 mg·kg^(-1)艾司氯胺酮;对照组给予等量0.9%NaCl,各组执行超前麻醉方案30 min后立即更改为自控静脉镇痛(PCIA)模式。评估各组术前、术后24 h内数字等级评定量表(NRS)评分,用酶联免疫吸附试验法检测钙-钙调素依赖性蛋白激酶Ⅲ(CAMKⅢ)、白细胞介素-6(IL-6)、脑源性神经营养因子(BDNF)、5-羟色胺(5-HT)变化,统计术后慢性术后疼痛(CPSP)发生率。记录药物不良反应发生情况。结果本研究共入组107例患者,共脱落5例,总计纳入102人,其中氟比洛芬酯组25例、艾司氯胺酮组26例、联合镇痛组26例、对照组25例。术后第24 h,氟比洛芬酯组、艾司氯胺酮组、联合镇痛组和对照组NRS评分分别为(3.27±0.14)、(3.75±0.42)、(2.35±0.12)和(4.25±0.77)分,PCIA泵平均按压次数分别为(3.14±0.75)、(4.22±0.62)、(2.15±0.92)和(5.11±1.02)次,CAMKⅢ浓度分别为(41.21±7.16)、(48.24±9.45)、(30.66±8.21)和(59.77±23.49)pg·mL^(-1),IL-6浓度分别为(22.26±0.04)、(24.12±0.01)、(10.48±0.07)和(40.09±0.17)pg·mL^(-1),BDNF浓度分别为(0.99±0.24)、(0.80±0.33)、(1.23±0.14)和(0.55±0.38)ng·mL^(-1),5-HT浓度分别为(155.91±19.56)、(139.57±18.81)、(185.24±22.50)和(116.25±16.88)ng·mL^(-1);氟比洛芬酯组、艾司氯胺酮组、联合镇痛组的上述指标和对照组比较,氟比洛芬酯组的上述指标与艾司氯胺酮组比较,氟比洛芬酯组和艾司氯胺酮组的上述指标与联合镇痛组比较,差异均有统计学意义(均Objective To observe the effect of flurbiprofen axetil combined with esketamine preemptive analgesia on postoperative analgesia in elderly patients undergoing hip replacement.Methods Elderly patients who met the indications of hip replacement and underwent surgical treatment were divided into flurbipofen axetil(FA)group,esketamine(ES)group,FA+ES group and control group by random number table method.All subjects stopped using anesthetics 30 min before the end of surgery,and the FA group was given 0.65 mg·kg^(-1)flurbiprofen axetil.ES group was given 0.35 mg·kg^(-1)esketamine;the FA+ES group was given 0.35 mg·kg^(-1)flurbiprofen ester+0.25 mg·kg^(-1)esketamine.The control group was given the same amount of 0.9%Na Cl,and the patient-controlled intravenous analgesia(PCIA)analgesia mode was changed immediately after 30 min of advanced anesthesia in each group.The numerical rating scale(NRS)scores of each group were evaluated before operation and within 24 h after operation.The changes of calciumcalmodulin-dependent protein kinaseⅢ(CAMKⅢ),interleukin-6(IL-6),brain-derived neurotrophic factor(BDNF)and 5-hydroxytryptamine(5-HT)were detected by enzyme-linked immunosorbent assay.The incidence of chronic postoperative pain(CPSP)was counted.The occurrence of adverse drug reactions was recorded.Results A total of 107 patients were enrolled in this study,5 were lost.A total of 102 patients were included,including 25 in the FA group,26 in the ES group,26 in the FA+ES group,and 25 in the control group.At 24 h after surgery,the NRS scores of FA group,ES group,FA+ES group and control group were(3.27±0.14),(3.75±0.42),(2.35±0.12)and(4.25±0.77)points,respectively;the average number of PCIA pump compressions was(3.14±0.75),(4.22±0.62),(2.15±0.92)and(5.11±1.02)times,respectively;the concentrations of CAMKⅢwere(41.21±7.16),(48.24±9.45),(30.66±8.21)and(59.77±23.49)pg·mL^(-1),respectively;the concentrations of IL-6 were(22.26±0.04),(24.12±0.01),(10.48±0.07)and(40.09±0.17)pg·mL^(-1),respectively;the concentrati

关 键 词：氟比洛芬酯 艾司氯胺酮 髋关节置换术 抑郁 真核延伸因子2激酶 白细胞介素6 脑源性神经营养因子 5-羟色胺 

分 类 号：R971.2[医药卫生—药品]