艾司氯胺酮对老年人全髋置换术后疲劳综合征的影响△

Effect of esketamine on fatigue syndrome after total hip arthroplasty in elderly

摘要:

[目的]探讨艾司氯胺酮对老年全髋置换术患者术后疲劳综合征的影响。[方法]183 例全髋置换术老年患者，随机分为给药组 （92 例） 和对照组 （91 例）。比较两组临床与检验结果。[结果] 给药组术中低血压发生率 （8.7% vs 19.8%, P= 0.039） 显著低于对照组。术后随时间推移，两组术后疲劳综合征 （postoperative fatigue syndrome, POFS） 发生率、疼痛 NRS 评分均显著改善 （P＜0.05）。给药组在术后 1 d （13.0% vs 28.6%, P=0.008）、3 d （8.7% vs 19.6%, P=0.026） 的 POFS 发生率，术后下地行走时间 [(7.6±1.3) h vs (8.2±1.6) h, P=0.006]、术后 7 d 内觉醒次数 [(82.6±9.2) 次 vs (90.2±9.3) 次, P＜0.001] 显著优于对照组。检验方面，与术前相比，术后即刻、术后 1、3 d，两组白介素-1β（interleukin-1β, IL-1β）、超敏 C 反应蛋白（hypersensi- tive C-reactive protein, hs-CRP）、皮质醇 、血清白介素-6（interleukin-6, IL-6）浓度均显著升高（P＜0.05），术前两组间上述检验指标的差异均无统计学意义 （P＞0.05），术后相应时间点，给药组上述检验指标均显著低于对照组 （P＜0.05）。[结论] 艾司氯胺酮降低老年全髋置换术患者早期 POFS 发生率，可能与抑制炎性反应、减少术中低血压、缩短下地行走时间、改善睡眠质量有关。

Abstract:

[Objective] To investigate the effect of esketamine (ESK) on fatigue syndrome after total hip arthroplasty (THA) in the elderly. [Methods] A total of 183 elderly patients who were undergoing THA were randomly divided into ESK group (92 cases) and control group (91 cases). The clinical and laboratory results of the two groups were compared. [Results] The ESK group proved significantly lower incidence of intraoperative hypotension than the control group (8.7% vs 19.8%, P=0.039). The occurrence of postoperative fatigue syndrome (POFS) and pain NRS score in both groups were significantly improved over time postoperatively (P＜0.05). The ESK group was significantly superior to the control group in terms of incidence of POFS 1 day (13.0% vs 28.6%, P=0.008) and 3 days postoperatively (8.7% vs 19.6%, P=0.026), as well as bed rest time [(7.6±1.3) hours vs (8.2±1.6) hours, P=0.006] and the number of awakening within 7 days after the operation [(82.6±9.2) times vs (90.2±9.3) times, P＜0.001]. As for blood test, the interleukin-1β (IL-1β), hypersensitive C-reactive protein (hsCRP), cortisol, serum interleukin-6 (IL-6) were significantly increased in both groups immediately after surgery, 1 and 3 days after surgery compared with those preoperatively (P＜0.05). There were no statistical significances in the above test indexes between the two groups before surgery (P＞0.05). However, the ESK group had significantly lower levels of the aforesaid test parameters than the control group at all corresponding time points after surgery (P＜0.05). [Conclusion] Esketamine reduces the incidence of POFS after THA in the elderly, which may be related to inhibiting inflammatory response, reducing intraoperative hypotension, shortening bed rest time and improving sleep quality.