艾司氯胺酮对腰椎间盘突出症患者髓核摘除术镇痛效果及应激反应的影响

doi:10.3969/j.issn.1006-6233.2022.12.034

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Abstract Objective: To explore the effect of esketamine on analgesia and stress response in patients with lumbar discectomy. Methods: A total of 102 patients undergoing nucleotomy who were admitted to our hospital from January 2021 to December 2021 were prospectively selected as the research subjects. They were divided into groups A and B by simple random coin tossing method, and 58 patients in group A were finally included. 44 cases in group B and endotracheal intubation were given general anesthesia. Before induction of anesthesia, patients in group A were intramuscularly injected with 1 mg/kg esketamine injection, and group B was intramuscularly injected with an equal volume of normal saline. The heart rate (HR), systolic blood pressure (SBP), and diastolic blood pressure (DBP) levels before and after anesthesia, as well as the number of analgesic pump compressions and visual analogue scale (VAS) at 3h and 6h after surgery were compared between the two groups. Visual analogue scale (VAS) was used to compare the oxidative stress (superoxide dismutase (SOD), malondialdehyde (MDA), glutathione peroxidase) before and 3 days after surgery between the two groups of patients (Glutathione peroxidase, GSH-Px)) and inflammatory factors (hypersensitive C-reactive protein (hs-CRP), interleukin-6 (interleukin-6, IL-6)) level changes. Results: After anesthesia, the levels of SBP and DBP in both groups decreased, and group A was significantly higher than group B, P<0. 05; analgesia pump compression was performed in group A 3 hours and 6 hours after operation. The frequency and VAS score were significantly lower than those in group B. The number of analgesic pump pressings and VAS score in groups A and B at 6 hours after operation were significantly higher than those at 3 hours after operation, P<0. 05; on the 3d postoperative period, the SOD, MDA and GSH-Px levels of patients in both groups were significantly reduced, and the SOD and GSH-Px levels of patients in group A were significantly higher than those in group B, and the MDA levels were significantly lower than those in group B. The comparison of the SOD, MDA and GSH-Px levels of patients in both groups before and in the 3d postoperative period, and the comparison of the difference of the decrease in SOD, MDA and GSH-Px levels in both groups in the 3d postoperative period compared with those before surgery The differences were statistically significant, P<0. 05;on 3d postoperatively, IL-6 and hs-CRP levels increased significantly in both groups, and IL-6 and hs-CRP levels in group A were significantly lower than those in group B. The differences between preoperative and 3d postoperative IL-6 and hs-CRP levels in both groups, and the difference between the elevation of IL-6 and hs-CRP levels in both groups in 3 d postoperatively compared with preoperatively, were statistically significant, P<0. 05. Conclusion: Esketamine has an ideal analgesic effect on patients with lumbar discectomy, and can effectively relieve pain, improve stress response, and inhibit inflammatory factors, which is worthy of clinical reference.

Key words： Esketamine Discectomy Analgesic effect Stress response Inflammatory factors

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http://www.hbyxzzs.cn/EN/10.3969/j.issn.1006-6233.2022.12.034 OR http://www.hbyxzzs.cn/EN/Y2022/V28/I12/2108