| 李雅楠,王利利,李颖.艾司氯胺酮对脊柱手术病人术后疼痛及炎症和应激反应的影响[J].安徽医药,2026,30(4):824-829. |
| 艾司氯胺酮对脊柱手术病人术后疼痛及炎症和应激反应的影响 |
| Effect of esketamine on postoperative pain and inflammatory and stress responses in patients undergoing spinal surgery |
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| DOI：10.3969/j.issn.1009-6469.2026.04.037 |
| 中文关键词: 麻醉药，静脉 麻醉，静脉 艾司氯胺酮 脊柱手术 术后疼痛 炎症反应 应激反应 |
| 英文关键词: Anesthetics,intravenous Anesthesia,intravenous response Stress response |
| 基金项目: |
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| 中文摘要: |
| 目的探讨艾司氯胺酮对脊柱手术病人术后疼痛及炎症和应激反应的影响及安全性。方法选择 2022年 9月至 2023年 3月于山西医科大学第二医院择期行脊柱手术的 86例病人作为研究对象。采取随机数字表法将病人分为艾司氯胺酮组(ES组)与对照组，每组 43例。两组病人均采用常规全身静脉麻醉，根据病人年龄、 ASA分级， ES组于切皮前静脉注射 0.25~0.50 mg/kg艾司氯胺酮，随后以 0.125 mg.kg.1.h.1持续泵注艾司氯胺酮，对照组给予等量 0.9%氯化钠溶液。记录术后 7d运动和静息时疼痛数字评价量表( NRS)评分；记录术中、术后 24 h及 48 h病人自控静脉镇痛( PCIA)的阿片类药物消耗量；记录 PCIA按压总次数、有效按压次数及术前( T1)、术后 1h(T2)机械痛阈水平；记录 T1、T2时刻炎症指标肿瘤坏死因子 α(TNF-α)、白细胞介素 -6(IL-6)、白细胞介素 -10(IL-10)、 C反应蛋白( CRP)及应激指标超氧化物歧化酶( SOD)、丙二醛、皮质醇、肾上腺素(E)、去甲肾上腺素( NE)水平变化；记录拔管时间及术后不良反应发生情况。结果两组病人共有 5例脱落。与对照组比较， ES组病人术后运动 NRS评分明显降低，术后 1d运动 NRS评分低于对照组［( 3.15±0.69)分比( 4.53±0.63)分］(P<0.05)，静息 NRS评分比较差异无统计学意义( P>0.05)术中及术后 24 h、48 h阿片类药物消耗量降低， PCIA按压次数明显减少，机械痛阈较高( P<0.05)；两组 T1时刻各反应指标水异均无统计学意义， T2时刻 TNF-α、IL-6、IL-10、CRP、SOD、皮质醇、 E、NE水平均平差，较 T1明显升高， ES组 MDA水平较 T1降低，对照组丙二醛水平较术前升高， ES组 TNF-α、IL-6、CRP、皮质醇、 E、NE、丙二醛水平明显低于对照组， IL-10、SOD水平明显高于对照组( P<0.05)；两组拔管时间及术后不良反应发生率比较差异无统计学意义( P>0.05)。结论在脊柱手术中应用艾司氯胺酮可有效降低病人术后疼痛，减少阿片类药物的消耗量及抑制炎症反应和应激反应，且安全性较高。 |
| 英文摘要: |
| Objective To investigate the effects and safety of esketamine on postoperative pain and inflammatory and stress respons-es in spinal surgery patients.Methods Eighty-six patients who underwent elective spinal surgery in The Second Hospital of ShanxiMedical University from September 2022 to March 2023 were selected as study subjects. Random number table method was adopted toassign the patients to esketamine group (ES group) or control group, with 43 cases in each group. Conventional general intravenous an-aesthesia was used in both groups, and according to the patients' age and ASA physical status classification, 0.25~0.50 mg/kg of esket-amine was intravenously injected in ES group before skin incision, followed by continuous pumping of esketamine at a rate of 0.125 mg.kg.1 .h.1, while an equal amount of saline was given in control group. The NRS (numerical rating scale) scores during exercise and restwere recorded on day 7 after surgery; the opioid consumption during intraoperative, 24 h and 48 h postoperative PCIA (patient-con-trolled intravenous analgesia) was recorded; the total number of PCIA attempts, the effective number of attempts and the mechanicalpain threshold levels of preoperative (T1) and 1 h postoperative (T2) PCIA were recorded; the changes in the levels of inflammatory indi-cators tumor necrosis factor α (TNF-α), interleukin-6 (IL-6), interleukin-10 (IL-10), C-reactive protein (CRP), and the stress indicatorssuperoxide dismutase (SOD), malondialdehyde (MDA),cortisol (Cor), epinephrine (E), and norepinephrine (NE) were recorded at T1 andT2 moments; the time of extubation and the occurrence of postoperative adverse reactions were recorded.Results There were 5 cases of detachment in both groups. Compared with control group, patients in ES group had significantly lower postoperative exercise NRSscores, with the NRS score on postoperative 1 d being lower than that of the control group [(3.15±0.69)points vs. (4.53±0.63)points] (P< 0.05), and there was no statistically significant difference in resting NRS score (P>0.05). The intraoperative and postoperative opioidconsumption was lower at 24 h and 48 h, and there was a significant reduction in the number of PCIA attempts and a higher mechanicalpain threshold (P<0.05). There was no statistically significant differences in the levels of response indices between the two groups at themoment of T1, and the levels of TNF-α, IL-6, IL-10, CRP, SOD, Cor, E, and NE at the moment of T2 were significantly higher thanthose at T1, and the level of MDA was lowered in the ES group than that at T1, and the level of MDA was higher in control group thanthat in the preoperative period. The levels of TNF-α, IL-6, CRP , Cor, E, NE, and MDA in ES group were significantly lower than those in control group, and IL-10 and SOD levels were significantly higher than those in control group (P<0.05). The differences in the extu-bation time and the incidence of postoperative adverse reactions between the two groups were not statistically significant (P<0.05).Con. clusion The use of esketamine in spinal surgery may effectively reduce postoperative pain in patients, reduces opioid consumptionand inhibits inflammatory and stress responses, with a high safety profile. |
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