作者：陈杰，李莎，李千一，侯阳阳，王森，任丽艳

单位：

1.河北工程大学附属医院麻醉科2.河北医科大学基础医学院3.河北工程大学附属医院手术部

Units：

1.Department of Anesthesiology, Affiliated Hospital of Hebei Engineering University, Handan 056002, China 2.School of Basic Medicine, Hebei Medical University, Shijiazhuang 050017, China 3.Operation Department, Affiliated Hospital of Hebei Engineering University, Handan 056002, China

关键词：

肺疾病,慢性阻塞性; 老年人; 髋关节置换术; 艾司氯胺酮; 右美托咪定;

Keywords：

Pulmonary disease, chronic obstructive; Aged; Hip replacement; Esketamine; Dexmedetomidine

CLC：

DOI：

10.12114/j.issn.1008-5971.2023.00.091

Funds：

河北省医学科学研究重点课题（20180801）；

摘要：

目的 分析艾司氯胺酮联合右美托咪定在老年慢性阻塞性肺疾病（COPD）患者髋关节置换术中的应用效果。方法 选取2020年11月至2022年3月河北工程大学附属医院骨科收治的拟行髋关节置换术的老年COPD患者118例为研究对象。采用随机数字表法将患者分为常规组、观察组，各59例。常规组患者采用右美托咪定进行麻醉，观察组患者采用艾司氯胺酮联合右美托咪定进行麻醉。比较两组基线资料，麻醉前（T0）、手术开始后10 min(T1)、手术结束后1 min(T2)血流动力学指标[心率、平均动脉压（MAP）]，围术期苏醒相关指标（术后苏醒时间、术后恢复室滞留时间），苏醒期躁动程度，术后4、24、48 h视觉模拟评分法（VAS）评分，不良反应发生率。结果 干预方法与时间在心率、MAP上存在交互作用（P<0.05）；干预方法、时间在心率、MAP上主效应显著（P<0.05）。观察组T1、T2时心率快于常规组，MAP低于常规组（P<0.05）；常规组、观察组T1时心率分别慢于本组T0时，MAP分别高于本组T0时（P<0.05）；常规组、观察组T2时心率分别快于本组T0、T1时，MAP分别高于本组T0时、低于本组T1时（P<0.05）。观察组术后苏醒时间、术后恢复室滞留时间短于常规组（P<0.05）。观察组苏醒期躁动程度轻于常规组（P<0.05）。干预方法与时间在VAS评分上不存在交互作用（P>0.05）；干预方法、时间在VAS评分上主效应显著（P<0.05）。观察组术后24、48 h VAS评分低于常规组（P<0.05）；常规组、观察组术后24、48 h VAS评分分别高于本组术后4 h，术后48 h VAS评分分别低于本组术后24 h(P<0.05)。两组围术期低血压、心动过缓、恶心呕吐发生率比较，差异无统计学意义（P>0.05）。结论 艾司氯胺酮联合右美托咪定可有效稳定老年COPD患者髋关节置换术中血流动力学指标，缩短术后苏醒时间，减轻术后苏醒期躁动程度及疼痛程度，且安全性好。

Abstract：

Objective To analyze the application effect of esmketamine combined with dexmedetomidine in hip replacement in elderly patients with chronic obstructive pulmonary disease (COPD) . Methods A total of 118 elderly patients with COPD who were admitted to the Department of Orthopedics, Affiliated Hospital of Hebei Engineering University from November 2020 to March 2022 and planned to undergo hip replacement were selected as the research objects. According to the random number table method, the patients were divided into the routine group and the observation group, with 59 cases in each group. Patients in the routine group were anesthetized with dexmedetomidine, and patients in the observation group were anesthetized with esketamine combined with dexmedetomidine. The baseline data, hemodynamic indexes [heart rate and mean arterial pressure (MAP) ] before anesthesia (T0) , 10 min after the beginning of operation (T1) , and 1 min after the end of operation (T2) , perioperative recovery related indexes (postoperative recovery time, postoperative recovery room retention time) , restlessness degree during awakening period, Visual Analogue Scale (VAS) score at 4, 24 and 48 hours after operation, and the incidence of adverse reactions were compared between the two groups. Results There was interaction between intervention method and time on heart rate and MAP (P < 0.05) . The main effects of intervention method and time on heart rate and MAP were significant (P< 0.05) . At T1 and T2, the heart rate of the observation group was faster than that of the routine group, and the MAP was lower than that of the routine group (P < 0.05) . The heart rate at T1 in the routine group and the observation group was slower than that at T0, and the MAP was higher than that at T0, respectively (P < 0.05) . In the routine group and the observation group, the heart rate at T2 was faster than that at T0 and T1, and the MAP was higher than that at T0 and lower than that at T1, respectively (P < 0.05) . The postoperative recovery time, postoperative recovery room retention time in the observation group were shorter than those in the routine group (P < 0.05) . The degree of agitation during awakening period in the observation group was lighter than that in the routine group (P < 0.05) . There was no interaction between intervention method and time on VAS score (P > 0.05) . The main effects of intervention method and time on VAS score were significant (P < 0.05) . The VAS scores at 24 and 48 hours after operation of the observation group were lower than those of the routine group (P < 0.05) . In the routine group and the observation group, the VAS scores at 24 and 48 hours after operation were higher than those at 4 hours after operation, and the VAS scores at 48 hours after operation were lower than those at 24 hours after operation, respectively (P < 0.05) . There was no statistically significant difference in the incidence of perioperative hypotension, bradycardia, and nausea and vomiting between the two groups (P > 0.05) . Conclusion Esmketamine combined with dexmedetomidine can effectively stabilize the hemodynamic indexes during hip replacement in elderly COPD patients, shorten the postoperative recovery time, reduce the degree of restlessness in the recovery period after operation and the degree of pain, and has good safety.

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