不同剂量艾司氯胺酮联合右美托咪定在老年髋部骨折中的应用效果

Application effects of different doses of esketamine combined with dexmedetomidine in elderly patients with hip fracture

摘要:

目的 探讨不同剂量艾司氯胺酮联合右美托咪定在老年髋部骨折中的应用效果。方法 选取2025年1月—2025年6月淮安八十二医院收治的120例老年髋部骨折患者，采用信封抽签法随机分为3组：对照组（40例，术中输注右美托咪定）、低剂量组（41例，低剂量艾司氯胺酮联合右美托咪定）、高剂量组（39例，高剂量艾司氯胺酮联合右美托咪定）。比较3组的镇痛效果［视觉模拟评分法（VAS）］，睡眠质量［匹兹堡睡眠质量指数（PSQI），失眠严重程度指数（ISI）］，炎症因子［白细胞介素-6（IL-6）、肿瘤坏死因子α（TNF-α）、白细胞介素-10（IL-10）］，手术开始时（T₁）、手术开始后30 min（T₂）、手术结束时（T₃）的血流动力学［平均动脉压（MAP）、心率（HR）］，以及不良反应。结果 术后2 h，低剂量组VAS评分低于高剂量组、对照组，高剂量组低于对照组（P <0.05）；术后12 h，低剂量组、高剂量组VAS评分低于对照组（P <0.05）。术后1、3 d，低剂量组PSQI评分、ISI评分低于高剂量组、对照组（P <0.05），高剂量组低于对照组（P <0.05）。术后24 h，低剂量组IL-6、TNF-α、IL-10水平低于对照组、高剂量组（P <0.05），高剂量组低于对照组（P <0.05）。低剂量组T₁、T₂、T₃的MAP高于对照组、高剂量组（P <0.05），高剂量组T₃时MAP高于对照组（P <0.05）；高剂量组T₁、T₂时HR高于对照组、低剂量组（P <0.05），低剂量组T₁、T₂、T₃时HR高于对照组（P <0.05）。高剂量组总不良反应发生率高于低剂量组、对照组（P <0.05）。结论 低剂量艾司氯胺酮联合右美托咪定方案更契合老年髋部骨折患者的生理特征，有助于提升围手术期安全性并改善术后恢复。

Abstract:

Objective To investigate the application effects of different doses of esketamine combined with dexmedetomidine in elderly patients with hip fracture.Methods A total of 120 elderly patients with hip fracture admitted to Huaian No. 82 Hospital from January 2025 to June 2025 were selected and randomly divided into three groups by envelope drawing method: a control group (n = 40, receiving intraoperative dexmedetomidine infusion), a low-dose group (n = 41, receiving low-dose esketamine combined with dexmedetomidine), and a high-dose group (n = 39, receiving high-dose esketamine combined with dexmedetomidine). The analgesic effect [assessed by Visual Analogue Scale (VAS) ], sleep quality [assessed by Pittsburgh Sleep Quality Index (PSQI) and Insomnia Severity Index (ISI) ], inflammatory factors [interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α), interleukin-10 (IL-10) ], hemodynamic parameters [mean arterial pressure (MAP), heart rate (HR) ] at the beginning of surgery (T₁), 30 minutes after the start of surgery (T₂), and the end of surgery (T₃), and adverse reactions were compared among the three groups.Results At 2 hours postoperatively, the VAS score of the low-dose group was lower than those of the high-dose group and the control group, and the score of the high-dose group was lower than that of the control group (P < 0.05). At 12 hours postoperatively, the VAS scores of the low-dose group and the high-dose group were lower than that of the control group (P < 0.05). At 1 and 3 days postoperatively, the PSQI and ISI scores of the low-dose group were lower than those of the high-dose group and the control group, and the scores of the high-dose group were lower than those of the control group (P < 0.05). At 24 hours postoperatively, the levels of IL-6, TNF-α, and IL-10 in the low-dose group were lower than those in the control group and the high-dose group, and the levels in the high-dose group were lower than those in the control group (P < 0.05). The MAP of the low-dose group at T₁, T₂, and T₃ was higher than that of the control group and the high-dose group (P < 0.05). The MAP of the high-dose group at T₃ was higher than that of the control group (P < 0.05). The HR of the high-dose group at T₁ and T₂ was higher than that of the control group and the low-dose group (P < 0.05). The HR of the low-dose group at T₁, T₂, and T₃ was higher than that of the control group (P < 0.05). The total incidence of adverse reactions in the high-dose group was higher than that in the low-dose group and the control group (P < 0.05).Conclusion The regimen of low-dose esketamine combined with dexmedetomidine is more in line with the physiological characteristics of elderly patients with hip fracture, contributing to improved perioperative safety and postoperative recovery.