膝关节置换术艾司氯胺酮对止血带损伤的影响△

Effect of esketamine on tourniquet injury in knee arthroplasty

摘要:

[目的]探讨膝关节置换术应用艾司氯胺酮对止血带损伤的影响。[方法]106 例全身麻醉下行膝关节置换术患者纳入研究。随机分为两组，53 例应用艾司氯胺酮（用药组）， 53 例常规全麻（未用药组）。比较两组临床与检验资料。[结果]两组患者均顺利完成手术。用药组止血带 60 min [(109.7±8.3) mmHg vs (115.7±9.5) mmHg, P＜0.001] 和松止血带 10 min 的平均动脉压 （mean artery pressure, MAP）[(102.6±7.4) mmHg vs (99.3±6.9) mmHg, P=0.019] 均显著低于未用药组。相应时间点，用药组 NRS 评分均显著低于未用药组（P＜0.05）。术后 7 d 用药组股部周径显著大于未用药组 [(42.7±5.4) cm vs (40.4±5.1) cm, P=0.026]，两组恶心呕吐、躁动发生率的差异无统计学意义（P＞0.05），用药组术后谵妄发生率显著低于未用药组（1.9% vs 15.1%, P=0.031）。检验方面，充气前，两组 IL-6、LA、MDA 水平的差异均无统计学意义 （P＞0.05），松止血 10 min 用药组 IL-6 [(407.3±26.7) pg/ml vs (432.5±28.7) pg/ml, P＜0.001]、LA [(0.8±0.2) mmol/L vs (1.0±0.2) mmol/L, P＜0.001]、MDA [(4.4±0.6) μmol/L vs (4.8±0.6) μmol/L, P＜ 0.001] 显著低于未用药组。[结论]膝关节置换术应用艾司氯胺酮具有抑制止血带高血压，减轻止血带疼痛，预防股四头肌萎缩的作用。

Abstract:

[Objective] To investigate the effect of esketamine on tourniquet injury in knee arthroplasty. [Methods] A total of 106 pa- tients who were undergoing knee arthroplasty under general anesthesia were included in the study. They were randomly divided into two groups, 53 patients received esketamine (the drug group), while other 53 patients not received esketamine (the non-drug group). The clinical and laboratory data of the two groups were compared. [Results] All patients in both groups were successfully operated on. The drug group had significantly lower mean artery pressure (MAP) than the non-drug group 60 min after torniquet applied [(109.7±8.3) mmHg vs (115.7± 9.5) mmHg, P＜0.001] and 10 min after torniquet released [(102.6±7.4) mmHg vs (99.3±6.9) mmHg, P=0.019]. At the corresponding time points, the drug group got significantly lower NRS score for pain than the non-drug group (P＜0.05). In addition, the drug group was mea- sured significantly greater femoral circumference than the non-drug group 7 days after operation [(42.7±5.4) cm vs (40.4±5.1) cm, P=0.026]. Regardless of insignificant difference in the incidence of nausea, vomiting and agitation between the two groups (P＞0.05), the drug group had significantly lower incidence of postoperative delirium than the non-drug group (1.9% vs 15.1%, P=0.031). In terms of laboratory test, al- though there were no statistically significant differences in IL-6, LA and MDA levels between the two groups before operation (P＞0.05). the drug group was tested significantly lower IL-6 [(407.3±26.7) pg/ml vs (432.5±28.7) pg/ml, P＜0.001], LA [(0.8±0.2) mmol/L vs (1.0±0.2) mmol/L, P＜0.001], and MDA [(4.4±0.6) μmol/L vs (4.8±0.6) μmol/L, P＜0.001] than the non-drug group 10 min after torniquet released. [Conclusion] Esketamine does inhibit tourniquet hypertension, relieve tourniquet pain and prevent quadriceps atrophy in knee arthroplasty in this study.