艾司氯胺酮预防性镇痛对胸腰椎骨折患者术后的影响  

Effect of prophylactic analgesia with esketamine on postoperativestatus in patients with thoracolumbar fracture

作　　者：季红霞 张国华[2] 张斌[1] 陈永红[1] JI Hongxia;ZHANG Guohua;ZHANG Bin;CHEN Yonghong(Department of Anesthesiology,Affiliated Nantong Hospital of Shanghai University,The Sixth People's Hospital of Nantong,Nantong,Jiangsu 226001,China;不详)

机构地区：[1]上海大学附属南通医院、南通市第六人民医院麻醉科,江苏南通226001 [2]南通市第三人民医院麻醉科,江苏南通226000

出　　处：《中国临床研究》2024年第8期1187-1191,共5页Chinese Journal of Clinical Research

基　　金：南通市卫生健康委员会科研项目(MSZ2023063)。

摘　　要：目的 探讨艾司氯胺酮预防性镇痛对单节段胸腰椎骨折患者经皮椎弓根螺钉内固定术(PPSF)治疗后疼痛、血流动力学和应激反应的影响。方法 选取2021年4月至2023年4月上海大学附属南通医院收治的行PPSF治疗的单节段胸腰椎骨折患者85例为研究对象。所有患者于气管插管全身麻醉下行PPSF,采取常规麻醉诱导、维持和术后自控静脉镇痛,其中42例患者于手术结束前20 min静脉推注艾司氯胺酮10 mg(观察组),43例患者不作该处理(对照组)。比较两组术后不同时间点疼痛[视觉模拟(VAS)评分]、血流动力学[心率(HR)、平均动脉压(MAP)、血氧饱和度(SpO_(2))及呼吸频率]、应激反应[嗜酸性粒细胞(EOS)、血小板计数(PLT)水平]及不良反应。结果 与对照组相比,T1(术毕)时观察组HR高,MAP低(P<0.05);术后2 h(T2)、术后6 h(T3)时观察组VAS评分低,术后48 h镇痛泵按压次数少(P<0.05),两组各时间点SpO_(2)、呼吸频率比较差异无统计学意义(P>0.05);T1、T3时观察组EOS水平高,PLT水平低(P<0.05)。观察组和对照组不良反应发生率差异无统计学意义(9.52%vs 4.65%,χ^(2)=0.206,P=0.433)。结论 艾司氯胺酮预防性镇痛有利于缓解单节段胸腰椎骨折患者PPSF治疗术后近期疼痛,减轻应激反应和稳定血流动力学,安全性好。Objective To explore the effects of prophylactic analgesia with esketamine on pain,hemodynamics,and stress response in patients with single-segment thoracolumbar fracture after percutaneous pedicle screw fixation(PPSF).Methods From April 2021 to April 2023,85 patients with single-segment thoracolumbar fracture undergoing PPSF at The Sixth People s Hospital of Nantong were enrolled as the research objects.All patients underwent PPSF under tracheal intubation and general anesthesia,routine anesthesia induction,maintenance and patient controlled intravenous analgesia.Among all the patients,42 cases in obeservation group were given intravenous injection of esketamine(10 mg)at 20 min before the end of the surgery,43 cases in control group did not receive any other treatment.The postoperative pain[visual analogue scale(VAS)],hemodynamics[heart rate(HR),mean arterial pressure(MAP),oxygen saturation(SpO_(2)),respiratory rate],stress response[eosinophils(EOS),platelet count(PLT)]and adverse reactions were compared between the two groups.Results Compared with control group,obeservation group had higher HR and lower MAP immediately after surgery(T1),lower VAS scores at 2 h(T2)and 6 h(T3)after surgery,and lower frequency of analgesic pump compression at 48 h after surgery(P<0.05).There was no significant difference in SpO_(2),respiratory rate between two groups(P>0.05).At T1 and T3,EOS was higher,while PLT was lower in observation group than control group(P<0.05).There was no statistically significant difference in the incidence of adverse reactions between the observation group and the control group(9.52%vs 4.65%,χ^(2)=0.206,P=0.433).Conclusion Prophylactic analgesia with esketamine is beneficial to relieve short-term pain,stress response and stabilize hemodynamics in patients with single-segment thoracolumbar fracture after PPSF,which has few effects on postoperative cognitive function and good safety.

关 键 词：胸腰椎骨折 艾司氯胺酮 预防性镇痛 疼痛 血流动力学 应激反应 

分 类 号：R614.2[医药卫生—麻醉学]