区锦辉 钟爱群 关志荣 陈炎恒 梁凌

【关键词】 艾司氯胺酮 咪达唑仑 血流动力学

[Abstract] Objective： To investigate the effect of Esketamine combined with Midazolam on anesthesia effect and cognitive function in elderly patients with lower limb fracture surgery. Method： A total of 92 elderly patients with lower limb fracture admitted to our hospital from January 2019 to June 2020 were selected， and they were divided into control group and observation group according to random number table method， 46 cases in each group. The control group was anesthetized with Dexmedetomidine combined with Esketamine， and the study group was anesthetized with Esketamine combined with Midazolam. Anesthesia effect， adverse reactions， hemodynamics and cognitive function were compared between two groups. Result： The rate of excellent and good anesthesia in the study group was higher than that in the control group， and the incidence of adverse reactions in the study group was lower than that in the control group， the differences were statistically significant （P<0.05）. At T1， there were no significant differences in HR， MAP and CVP between two groups （P>0.05）. At T2-T5， HR， there were no significant differences in HR， MAP and CVP between the control group and T1 （P<0.05）. At T2-T5， there were no significant differences in HR， MAP and CVP between the study group and T1 （P>0.05）. At T2-T5， HR， MAP and CVP in the study group were lower than those in the control group， the differences were statistically significant （P<0.05）. The onset time of anesthesia in the study group was shorter than that in the control group， and the sedation and VAS scores in the study group were lower than those in the control group， the differences were statistically significant （P<0.05）. Before surgery， there was no significant difference in MMSE score between two groups （P>0.05）; 1 and 3 d after surgery， MMSE scores in the study group were higher than those in the control group， the differences were statistically significant （P<0.05）. Conclusion： The application of Esketamine combined with Midazolam in the external fixation of lower extremity fractures in elderly patients is effective， has little effect on hemodynamics， is beneficial to improve cognitive function， has ideal sedative effect， has fewer adverse reactions， is safe， which is worthy of extensive promotion.

[Key words] Esketamine Midazolam Hemodynamics

First-author’s address： Gaoming District People’s Hospital， Foshan 528500， China

doi：10.3969/j.issn.1674-4985.2021.26.041

临床选择何种治疗方式对老年下肢骨折具有十分重要的意义。现阶段常采用外固定支架固定术固定患者骨折处，促进骨折愈合。但是老年患者容易在手术时出现较大的应激反应，而且强烈的疼痛能够提升其内分泌以及心血管系统等并发症发生的风险，不利于康复，降低其预后[1]。有研究显示，老年患者在手术后1 d发生认知障碍的概率达17%[2]。在手术中选取安全有效的麻醉药物对降低老年患者发生呼吸抑制的风险具有十分重要意义。本文分析艾司氯胺酮联合咪达唑仑在老年下肢骨折患者术中的应用，现报道如下。

1 资料与方法

1.1 一般资料 选取2019年1月-2020年6月本院收治的92例下肢骨折老年患者。纳入标准：（1）患者依据美国麻醉医师协会（ASA）麻醉分级为Ⅱ、Ⅲ级[3];（2）对本研究所使用药物不过敏;（3）拟行外固定支架固定术。排除标准：（1）合并精神障碍;（2）合并其他重大疾病，如免疫系统、血液系统;（3）存在手术禁忌证;（4）中途退出。根据随机数字表法将患者分为对照组和研究组，每组46例。本研究经过医院伦理委员会批准，患者均知情同意。

1.2 方法 两组均行下肢骨折固定支架固定术，患者在术前8 h禁食，术前4 h禁水，并对其进行常规检查，评估其营养状况，进行低浓度供氧。下肢骨折手术以腓骨骨折为例。患者采用硬膜外麻醉，呈平卧位，在胫骨结节到内踝连接骨折上端和下端并各固定1枚整复针，然后在C型臂X线机下使用手法复位的同时并配合经皮撬拨。……