小剂量艾司氯胺酮联合舒芬太尼减轻全髋关节置换术老年患者围手术期炎性反应  

Small-dose esketamine combined with sufentanil reduces perioperative inflammation in elderly patients with total hip replacement

作　　者：杨文 李勇[1] 杨淖绚 YANG Wen;LI Yong;YANG Zhuoxuan(Department of Anesthesiology,People′s Hospital of Ya′an,Ya′an 625000,China)

机构地区：[1]雅安市人民医院麻醉科,四川雅安625000

出　　处：《基础医学与临床》2025年第1期60-64,共5页Basic and Clinical Medicine

基　　金：雅安市重点科技计划项目(21KJJH0027)。

摘　　要：目的分析小剂量艾司氯胺酮联合舒芬太尼对全髋关节置换术(THA)老年患者围手术期炎性反应和免疫功能的影响。方法2019年1月至2022年1月期间,收集在腰-硬联合麻醉下接受THA的120例老年患者,均接受经静脉患者自控镇痛(PCIA),将患者分成对照组(镇痛药物为舒芬太尼+格拉司琼)和观察组(镇痛药物为艾司氯胺酮+舒芬太尼+格拉司琼)。视觉模拟评分(VAS)法评估患者疼痛程度;ELISA检测血清白细胞介素(IL)-6、肿瘤坏死因子(TNF)-α与C-反应蛋白(CRP)水平;用CytoFLEX流式细胞仪测定CD4^(+)、CD8^(+)水平,并计算CD4^(+)/CD8^(+)比值;记录比较两组患者不良反应发生情况。结果静息状态下,观察组患者术后48和72 h的VAS评分显著低于对照组,活动状态下,观察组患者术后24、48和72 h的VAS评分显著低于对照组(P<0.05)。与同组术前24 h相比,对照组术后24、48和72 h IL-6、TNF-α、CRP水平显著升高,观察组术后24和48 h IL-6、TNF-α、CRP水平升高,术后72 h恢复至术前水平(P<0.05)。术后24、48和72 h观察组患者IL-6、TNF-α、CRP水平显著低于对照组(P<0.05)。与同组术前24 h相比,术后24、48和72 h观察组CD8^(+)(%)上升,CD4^(+)(%)与CD4^(+)/CD8^(+)下降,术后24和48 h观察组患者CD8^(+)(%)上升,CD4^(+)(%)与CD4^(+)/CD8^(+)下降,术后72 h恢复至术前水平。术后24、48和72 h观察组患者CD8^(+)(%)、CD4^(+)(%)与CD4^(+)/CD8^(+)水平显著高于对照组(P<0.05)。两组患者不良反应发生情况差异无统计学意义。结论小剂量艾司氯胺酮联合舒芬太尼可降低THA老年患者围手术期炎性反应,对免疫功能的影响较小。Objective To analyze the impact of low-dose esketamine combined with sufentanil on peri-operative inflammation and immune function of elderly patients undergoing total hip arthroplasty(THA).Methods From January 2019 to January 2022,120 elderly patients who underwent THA under combined spinal-epidural anesthesia and received patient-controlled intravenous analgesia(PCIA)were included.The patients were divided into a control group(analgesic drugs:sufentanil+granisetron)and an observation group(analgesic drugs:esket-amine+sufentanil+granisetron).Pain intensity was assessed using the Visual Analog Scale(VAS).Serum level of interleukin(IL)-6,tumor necrosis factor(TNF)-αand C-reactive protein(CRP)was measured by ELISA.CD4^(+)and CD8^(+)cells were detected using a CytoFLEX flow cytometer,and the CD4^(+)/CD8^(+)ratio was calculated.The incidence of adverse reactions in both groups was recorded and compared.Results In resting state,the post-surgical VAS scores in the observation group patients were significantly lower than those in control group at 48 and 72 h.In the active state,the VAS scores recorded for the observation group following surgery remained notably lower than those of the control group at 24,48,72 h(P<0.05).Compared with 24 h before surgery in the same group,the level of IL-6,TNF-α,and CRP in the control group significantly increased at 24,48,and 72 h after surgery,while in the observation group,they increased at 24 and 48 h after surgery and returned to pre-operative level at 72 h(P<0.05).The observation group exhibited significantly lower level of IL-6,TNF-αand CRP as compared to the control group over the 24,48,72 h following surgery(P<0.05).Compared with 24 h before surgery in the same group,CD8^(+)(%)increased,while CD4^(+)(%)and CD4^(+)/CD8^(+)decreased in the observation group at 24,48,and 72 h after surgery.However,72 h after surgery,these values returned to the level before operation.Twenty four,48,and 72 h after surgery,the observation group displayed notably elevated level of CD8^(+)(%),CD4^(+

关 键 词：艾司氯胺酮 舒芬太尼 全髋关节置换术 免疫功能 炎性反应 

分 类 号：R687.4[医药卫生—骨科学]