艾司氯氨酮自控静脉镇痛联合连续髋关节囊周围神经阻滞对老年全髋关节置换术后镇痛的影响

Effect of esketamine patient-controlled intravenous analgesia combined with continuous pericapsular nerve group block on postoperative analgesia in elderly patients undergoing total hip arthroplasty

摘要:

目的 分析艾司氯氨酮自控静脉镇痛（PCIA）联合连续髋关节囊周围神经阻滞（PENGB）对老年全髋关节置换术（THA）后镇痛的影响。方法 回顾性分析2019年4月—2023年7月在宜兴市中医医院行THA的95例老年患者的临床资料，按照不同麻醉方法将其分为对照组和观察组。对照组（46例）采用艾司氯氨酮PCIA联合常规腰丛阻滞，观察组（49例）采用PCIA联合连续髋关节囊PENGB，比较两组镇痛效果。结果 实验组与对照组麻醉前（T₀）、麻醉完成后10 min（T₁）、术后20 min（T₂）时、术后3 h（T₃）、术后6 h（T₄）、术后24 h（T₅）的心率（HR）和平均动脉压（MAP）水平比较，结果 ①不同时间点HR和MAP水平比较，差异有统计学意义（P <0.05）；②实验组与对照组HR和MAP水平比较，差异有统计学意义（P <0.05）；③两组HR和MAP水平变化趋势比较，差异有统计学意义（P <0.05）。观察组术后12 h与24 h的肾上腺素、β-内啡肽的差值均小于对照组（P <0.05）。观察组术后12 h与24 h的神经肽Y、P物质、前列腺素E2、静息时疼痛评分和活动时疼痛评分的差值均大于对照组（P <0.05）。观察组镇痛泵按压次数和补救镇痛率均低于对照组（P <0.05）。观察组与对照组不良反应总发生率比较，差异无统计学意义（P >0.05）。结论 采用艾司氯氨酮PCIA联合连续PENGB对老年THA可显著减轻疼痛介质和疼痛程度，降低患者应激反应，且血流动力学较稳定，不良反应较少。

Abstract:

Objective To analyze the effect of esketamine patient-controlled intravenous analgesia (PCIA) combined with continuous pericapsular nerve group block (PENGB) on postoperative analgesia in elderly patients undergoing total hip arthroplasty (THA).Methods The clinical data of 95 elderly patients undergoing THA from April 2019 to July 2023 at Yixing Traditional Chinese Medicine Hospital were retrospectively analyzed. The patients were divided into two groups according to different anesthesia approaches, where the control group (n = 46) received esketamine PCIA combined with conventional lumbar plexus block, and the observation group (n = 49) received PCIA combined with PENGB. The analgesic effect was compared between the two groups.Results Comparison of HR and MAP between the observation and control groups before anesthesia (T₀), 10 min after anesthesia completion (T₁), 20 min postoperatively (T₂), 3 h postoperatively (T₃), 6 h postoperatively (T₄), and 24 h postoperatively (T₅) revealed that they differed significantly across time points (P < 0.05) and between the groups (P < 0.05), and that the overall trends in HR and MAP changes also differed significantly between the two groups (P < 0.05). At 12 h and 24 h postoperatively, the differences in epinephrine and β-endorphin levels were significantly lower in the observation group compared with the control group (P < 0.05). In contrast, the changes in neuropeptide Y, substance P, prostaglandin E2, resting pain scores, and pain scores at rest and on movement were significantly greater in the observation group (P < 0.05). The observation group required fewer PCIA pump presses and had a lower rate of rescue analgesia compared with the control group (P < 0.05). The overall incidence of adverse events did not differ significantly between the two groups (P > 0.05).Conclusion Esketamine PCIA combined with continuous PENGB significantly reduces the pain mediators and pain intensity, attenuates the stress response, maintains hemodynamic stability, and is associated with fewer adverse events in elderly patients undergoing THA.