艾司氯胺酮联合咪达唑仑对接受股骨颈骨折置换术老年患者的影响  

Efficacy of esketamine combined with midazolam in elderly patient undergoing femoral neck fracture replacement surgery

作　　者：卢强[1] 董春山[1] 马祥[1] LU Qiang;DONG Chunshan;MA Xiang(Department of Anesthesiology,the First People’s Hospital of Hefei,Hefei 230061,China)

机构地区：[1]合肥市第一人民医院麻醉科,合肥230061

出　　处：《西北药学杂志》2024年第6期234-240,共7页Northwest Pharmaceutical Journal

基　　金：合肥市卫计委2018年应用医学研究项目(编号:hwk2018zd014)。

摘　　要：目的探究亚麻醉剂量艾司氯胺酮联合咪达唑仑对接受股骨颈骨折置换术老年患者血流动力学和术后谵妄发生的影响。方法选取86例老年股骨颈骨折患者作为研究对象,用随机数字表法分为联用组和对照组,每组43例。2组均在静脉吸入复合气管插管全身麻醉复合神经阻滞麻醉下进行人工股骨头置换术,麻醉诱导前10 min,对照组静脉注入0.02 mg·kg^(−1)咪达唑仑,联用组静脉注入0.2 mg·kg^(−1)艾司氯胺酮和0.02 mg·kg^(−1)咪达唑仑。比较2组患者的围手术期血流动力学指标、手术相关指标、疼痛视觉模拟量表(visual analogue scale,VAS)评分、认知功能简易精神状态评价量表(mini-mental state examination,MMSE)评分、术后谵妄和药物不良反应的发生情况。结果联用组手术开始时和结束时的平均动脉压(mean arterial pressure,MAP)和心率(heart rate,HR)均高于对照组(P<0.05),舒芬太尼及瑞芬太尼用量少于对照组,苏醒时间短于对照组(P<0.05);联用组术后30 min、2 h和1 d的VAS评分均低于对照组(P<0.05),术后1 d的MMSE评分高于对照组(P<0.05);联用组术后谵妄发生率低于对照组(P<0.05);2组的不良反应发生率比较差异无统计学意义(P>0.05)。结论亚麻醉剂量艾司氯胺酮联合咪达唑仑应用于老年股骨颈骨折手术患者,可维持患者的血流动力学稳定,减少舒芬太尼及瑞芬太尼用量,促进患者苏醒,提高镇痛效果,降低术后谵妄的发生率。Objective To explore the efficacy of esketamine combined with midazolam in elderly patient undergoing femoral neck fracture replacement surgery.Methods 86 elderly patients with femoral neck fractures admitted to the hospital were selected and divided into a combined group and a control group according to random number table method,with 43 cases in each group.The both groups underwent artificial femoral head replacement under general anesthesia intubation intravenous inhalation combined with nerve block anesthesia.At 10 minutes before anesthesia induction,the control group was intravenously injected with 0.02 mg·kg^(−1)of midazolam,while the combined group was intravenously injected with a mixture of 0.2 mg·kg^(−1)of esketamine and 0.02 mg·kg^(−1)of midazolam.The perioperative hemodynamic indicators,surgery-related indicators,visual analogue scale(VAS)score,cognitive function(mini-mental state examination,MMSE)score,the incidence rate of postoperative delirium and the occurrence of other adverse anesthesia reactions were compared between the 2 groups.Results The mean arterial pressure(MAP)and heart rate(HR)in the combined group were higher than those in the control group at the beginning of surgery and at the end of the surgery(P<0.05).The dosage of sufentanil and dosage of remifentanil were less in the combined group than those in the control group,and the recovery time was shorter than that in the control group(P<0.05).The VAS scores at 30 minutes,2 hours and 1 day after surgery in combined group were lower than those in the control group(P<0.05).The MMSE score in the combined group at 1 day after surgery was higher than that in the control group(P<0.05).The incidence rate of postoperative delirium in the combined group was lower than that in the control group(P<0.05).There was no statistically significant difference in nausea and vomiting,bradycardia,rash,dizziness,respiratory depression and other adverse reactions between the 2 groups(P>0.05).Conclusion The application of subanesthetic dose of esketam

关 键 词：艾司氯胺酮 咪达唑仑 亚麻醉剂量 老年 股骨颈骨折 谵妄 

分 类 号：R971[医药卫生—药品]