| 摘要: |
| 目的:探讨艾司氯胺酮联合针灸治疗对老年髋部骨折患者术后胃肠功能恢复的影响。方法:选取2023年4月—12月在我院择期行髋部骨折手术的老年患者80例，ASA分级为Ⅱ~Ⅲ级，采用随机数字表法分成对照组与观察组，每组40例。对照组围术期采用常规治疗，观察组较对照组于术中静脉给予艾司氯胺酮联合术后针灸治疗的策略。记录并比较两组术中手术时间、晶体量、胶体量、出血量、尿量及术中舒芬太尼、瑞芬太尼用量，患者入手术室(T0)、置入假体(T1)、手术结束(T2)、出手术室(T3)共4个时点的心率(HR)、平均动脉压(MAP)、经皮脉搏血氧饱和度(SpO2)数值。采集患者T0和术后24 h(T4)的静脉血4～5 mL，ELISA法测定血浆C-反应蛋白(CRP)与内毒素(EN)浓度。随访患者术后胃肠功能恢复自主通气、排便时间。观察术后不良事件:发热，腹痛、腹胀，术后0～24 h、24～48 h疼痛数字评分(NRS)、恶心呕吐(PONV)的发生情况及术后住院时间。结果:与对照组比较，观察组术中舒芬太尼用量较对照组显著减少；术中HR数值在T1、T2时刻显著降低；术后血浆CRP与EN数值在T4时刻显著下降。观察组患者较对照组术后恢复自主通气、排便时间明显缩短；观察组术后0～24 h的NRS评分较对照组显著下降。结论:老年髋部骨折患者围术期采用艾司氯胺酮联合针灸治疗的策略可促进术后胃肠功能早期恢复。其机制可能是通过减少术中阿片类药物用量，降低术后疼痛反应程度，减轻围术期炎症反应，更好地保护患者的胃肠道黏膜屏障功能而发挥了积极作用。 |
| 关键词: 艾司氯胺酮 针灸 胃肠功能 髋部骨折 老年 内毒素 |
| DOI：10.3969/j.issn.1007-6948.2025.04.013 |
| 投稿时间：2025-02-03 |
| 基金项目:扬州市科技局社会发展指导性项目(YZ22023134) |
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| 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 |
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| 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. |
| Key words: Esketamine acupuncture gastrointestinal function hip fracture elderly endotoxin |
