目的 探讨不同剂量的艾司氯胺酮+右美托咪定的应用对临床髋部骨折患者术后睡眠质量与认知功能的影响。方法 采取随机数字表法将河南科技大学临床学院2023年7月至2024年7月收治的90例老年髋部骨折手术患者分成N组、L组与H组各30例,N 组为空白对照组,术中输注右美托咪定作对照组;L组为低剂量艾司氯胺酮组,术中输注右美托咪定联合低剂量艾司氯胺酮;H组为高剂量艾司氯胺酮组,术中输注右美托咪定联合高剂量艾司氯胺酮,对比3组患者术中血流动力学改变、术后镇静疼痛与术后睡眠等情况。结果 L组与H组患者术中各时段血流动力学更平稳,且N组患者在进入麻醉恢复室（PACU）即刻、进入30 min后与进入60 min后各时段的镇静评分（RASS）均显著高于L组与H组（P<0.05）,而VAS评分则显著高于L组与H组（P<0.05）,且VAS评分,L组显著低于H组（P<0.05）;同时,术后3组患者的主客观睡眠质量均显著改善,且以L组改善效果最为显著。结论 艾司氯胺酮+右美托咪定在临床老年髋部骨折患者术中麻醉的应用,且以小剂量艾司氯胺酮的效果更好。
Abstract
Objective To investigate the effects of different doses of Esketamine + Dexmedetomidine on postoperative sleep quality and cognitive function of patients with hip fracture. Methods From July 2023 toJuly 2024, 90 elderly patients undergoing hip fracture surgery in the Clinical College of Henan University of Science and Technology were randomly divided into N group, L group and H group, with 30 patients in each group. N group was the blank control group, and dexmedetomidine was infused during the operation as the control group. Group L was low-dose Esketamine group, and dexmedetomidine combined with low-dose Esketamine was infused during operation. Group H was the high-dose Esketamine group, and dexmedetomidine combined with high-dose Esketamine was infused during the operation. The hemodynamic changes, postoperative sedation pain and postoperative sleep were compared among the three groups. Results The hemodynamics of patients in group L and group H were more stable in PACU period of operation, and the sedation scores (Richmond Agitation and Sedation Scale, RASS) was significantly higher than that of group L and group H (P<0.05), while the VAS score was significantly higher than that of group L and group H (P<0.05), and the VAS score of group L was significantly lower than that of group H (P<0.05). At the same time, the subjective and Objective sleep quality of the three groups were significantly improved after operation, and the improvement effect of L group was the most significant. Conclusions Esketamine + Dexmedetomidine is used in the anesthesia of elderly patients with hip fracture, and the effect of low dose Esketamine is better.
关键词
髋部骨折 /
艾司氯胺酮 /
右美托咪定 /
睡眠 /
术后谵妄
Key words
Hip fracture /
Esketamine /
Dexmedetomidine /
Sleep /
Postoperative delirium
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