Effect of esketamine combined with acupuncture therapy on gastrointestinal function recovery in elderly patients undergoing hip fracture surgery
LIU Han-qin,CUI Shi-he,ZHOU Lei
Abstract:
Objective To explore the application of esketamine combined with acupuncture on the effect of postoperative gastrointestinal function recovery in elderly patients with hip fracture. Methods 80 elderly patients undergoing elective hip fractures, ASA grades Ⅱ-Ⅲ, were selected and randomly divided into an observation group and a control group using a random number table, with 40 patients in each group.The control group adopted routine treatment measures during the perioperative period, and the observation group was compared with the control group in the strategy of intravenous administration of esketamine and postoperative acupuncture. Intraoperative operation time, blood loss, crystal quantity, colloidal quantity urine and the dosage of sufentanil and remifentanil were recorded. The values of MAP, HR and SPO2 were documented at the same time of before operation(T0), prosthesis placement(T1), the end of surgery(T2) and departure(T3). The plasma concentrations of endotoxin(EN) and C-reactive protein(CRP) were quantitatively measured at T0 and 24 hours after surgery(T4). The patients were followed up with the time of the recovery of spontaneous ventilation and defecation.Fever, abdominal pain and distention, numerical rating scale (NRS) score at 0-24 h and 24-48 h after surgery, incidence of postoperative nausea and vomiting (PONV) and hospital stay were analyzed. Results Compared with the control group, the observation group showed a significant reduction in the amount of sufentanil used during surgery. The intraoperative HR values significantly decreased at T1 and T2 time points. The postoperative plasma CRP and EN values significantly decreased at T4. Compared with the control group, the time of spontaneous ventilation and defecation in the observation group was significantly shorter than that in the control group. There was significant difference in the NRS score of pain from 0 to 24 h after surgery. Conclusions The perioperative strategy of acupuncture combined with esketamine can promote the early recovery of gastrointestinal function in elderly patients with hip fracture. The mechanism may have played a positive role by reducing the amount of opioid drugs used during surgery, lowering the degree of postoperative pain response, alleviating perioperative inflammatory reactions, and protecting the intestinal mucosal barrier function.
