摘要
目的观察艾司氯胺酮预处理对臂丛神经阻滞上肢骨折切开复位内固定术患者血清去甲肾上腺素(NE)、肾上腺素(E)、皮质醇(Cor)水平的影响。方法前瞻性选取2024年6月至2024年12月重庆大学附属三峡医院行臂丛神经阻滞上肢骨折切开复位内固定术的78例患者,采用随机数字表法分为研究组与对照组,每组39例,研究组给予艾司氯胺酮预处理,对照组给予等量生理盐水。对比两组不同时间点的血清NE、E、Cor水平,炎症因子水平,疼痛程度以及术后不良反应发生率。结果在T1、T2、T3时,研究组血清NE[分别是(1.43±0.44)pg·mL^(-1)、(1.54±0.52)pg·mL^(-1)、(1.51±0.49)pg·mL^(-1)]、E[分别是(0.63±0.21)pg·mL^(-1)、(0.72±0.24)pg·mL^(-1)、(0.69±0.30)pg·mL^(-1)]、Cor[(246.53±58.76)ng·mL^(-1)、(269.67±65.37)ng·mL^(-1)、(279.06±69.41)ng·mL^(-1)],和对照组血清NE[(2.23±1.03)pg·mL^(-1)、(2.98±1.36)pg·mL^(-1)、(2.67±1.19)pg·mL^(-1)]、E[(0.83±0.32)pg·mL^(-1)、(0.93±0.39)pg·mL^(-1)、(0.87±0.34)pg·mL^(-1)]、Cor[(302.59±75.36)ng·mL^(-1)、(339.64±80.96)ng·mL^(-1)、(356.49±83.41)ng·mL^(-1)],高于T0时[研究组NE、E、Cor分别是(1.05±0.31)pg·mL^(-1)、(0.36±0.12)pg·mL^(-1)、(205.39±41.87)ng·mL^(-1),对照组NE、E、Cor分别是(1.08±0.36)pg·mL^(-1)、(0.39±0.18)pg·mL^(-1)、(207.42±43.99)ng·mL^(-1)];两组T1、T2、T3时血清NE、E、Cor水平均升高,且研究组低于对照组(P<0.05)。术后12 h、24 h时,研究组IL-6[(67.48±7.96)ng·L^(-1)和(52.36±4.69)ng·L^(-1)]、TNF-α[(26.78±6.15)ng·L^(-1)和(19.79±5.78)ng·L^(-1)]、IL-2[(62.38±8.32)pg·mL^(-1)和(53.24±5.12)pg·m L^(-1)]、CRP[(21.36±3.12)mg·L^(-1)和(14.35±2.56)mg·L^(-1)]和对照组IL-6[(78.96±8.46)ng·L^(-1)和(56.74±5.23)ng·L^(-1)]、TNF-α[(32.95±5.67)ng·L^(-1)和(26.36±6.24)ng·L^(-1)]、IL-2[(69.41±9.41)pg·mL^(-1)和(56.34±6.09)pg·mL^(-1)]、CRP[(24.69±3.34)mg·L^(-1)和(17.97±3.41)mg·L^(-1)],高于T0时研究组[IL-6、TNF-α、IL-2、CRP分别是(31.36±8.69)ng·L^(-1)、(18.24±7.36)ng·L^(-1)、(48.09±5.31)pg·mL^(-1)、(13.12±2.61)mg·L^(-1)]和对照组[IL-6、TNF-α、IL-2、CRP分别是(31.06±8.21)ng·L^(-1)、(19.46±6.97)ng·L^(-1)、(48.29±6.13)pg·mL^(-1)、(13.23±2.59)mg·L^(-1)],且研究组低于对照组(P<0.05)。术后6 h、12 h、24 h的疼痛程度,研究组[分别是(3.79±0.57)分、(3.21±0.61)分、(2.85±0.41)分]和对照组[分别是(4.25±0.69)分、(3.89±0.74)分、(3.24±0.34)分],低于术后3 h[研究组和对照组分别是(3.96±0.72)分、(4.78±0.97)分]。研究组术后不良反应发生率(7.69%)低于对照组(28.21%),差异有统计学意义(P<0.05)。结论艾司氯胺酮预处理可降低臂丛神经阻滞上肢骨折切开复位内固定术患者的血清NE、E、Cor水平,且可有效改善机体炎症反应,使疼痛程度以及术后不良反应发生率下降。
Objective To observe the effect of esketamine pretreatment on serum norepinephrine(NE),epinephrine(E)and cortisol(Cor)levels in patients undergoing open reduction and internal fixation for upper limb fracture under brachial plexus block.Methods Seventy-eight patients who underwent open reduction and internal fixation for upper limb fracture under brachial plexus block in Three Gorges Hospital Affiliated to Chongqing University from June 2024 to December 2024 were selected as the research subjects and divided into two groups using random number table methods,with 39 in each group.The patients in the study group were pretreated with esketamine,and those in the control group were given an equal amount of saline.Then the serum NE,E,and Cor levels,inflammatory factors,pain degree and incidence of postoperative adverse events were compared between the two groups at different time points.Results The levels of serum NE,E,and Cor at time points T1,T2,and T3 in the study group and control group were higher than those at time point T0((1.43±0.44)pg·mL^(-1),(1.54±0.52)pg·mL^(-1),(1.51±0.49)pg·mL^(-1),(0.63±0.21)pg·mL^(-1),(0.72±0.24)pg·mL^(-1),(0.69±0.30)pg·mL^(-1),(246.53±58.76)ng·mL^(-1),(269.67±65.37)ng·mL^(-1),(279.06±69.41)ng·mL^(-1),(2.23±1.03)pg·mL^(-1),(2.98±1.36)pg·mL^(-1),(2.67±1.19)pg·mL^(-1),(0.83±0.32)pg·mL^(-1),(0.93±0.39)pg·mL^(-1),(0.87±0.34)pg·mL^(-1),(302.59±75.36)ng·mL^(-1),(339.64±80.96)ng·mL^(-1),and(356.49±83.41)ng·mL^(-1)).The levels of serum NE,E,and Cor at time points T1-T3 were increased in both groups,and they were lower in the study group than in the control(P<0.05).The levels of IL-6,TNF-α,IL-2,and CRP in the study group and control group at 12 and 24 hours after operation were higher than those at the time point of T0((67.48±7.96)ng·L^(-1),(52.36±4.69)ng·L^(-1),(26.78±6.15)ng·L^(-1),(19.79±5.78)ng·L^(-1),(62.38±8.32)pg·mL^(-1),(53.24±5.12)pg·mL^(-1),(21.36±3.12)mg·L^(-1),(14.35±2.56)mg·L^(-1),(78.96±8.46)ng·L^(-1),(56.74±5.23)ng·L^(-1),(32.95±5.67)ng·L^(-1),(26.36±6.24)ng·L^(-1),(69.41±9.41)pg·mL^(-1),(56.34±6.09)pg·mL^(-1),(24.69±3.34)mg·L^(-1),(17.97±3.41)mg·L^(-1)),and they were lower in the study group than in the control(P<0.05).The pain levels of the study group and control group at 6 h,12 h and 24 h after surgery((3.79±0.57)points,(3.21±0.61)points,(2.85±0.41)points,(4.25±0.69)points,(3.89±0.74)points,(3.24±0.34)points)were lower than those at 3 h after surgery((3.96±0.72)points,(4.78±0.97)points).The pain levels decreased with time,and they were lower in the study group than in the control(P<0.05).The incidence of adverse reactions in the study group was 7.69%,which was lower than that in the control(28.21%)(P<0.05).Conclusion The esketamine pretreatment for patients undergoing open reduction and internal fixation for upper limb fracture under brachial plexus block is effective because it can effectively reduce serum NE,E,and Cor levels,attenuate inflammatory response,alleviate pain,and reduce incidence rate of postoperative adverse effects.
作者
胡娟
王洪
Hu Juan;Wang Hong(Department of Anesthesiology,Three Gorges Hospital Affiliated to Chongqing University,Chongqing 404000,China)
出处
《中国药物应用与监测》
2025年第3期519-522,共4页
Chinese Journal of Drug Application and Monitoring
作者简介
通信作者:王洪,Email:616977473@qq.com。
