艾司氯胺酮用于老年股骨骨折手术去阿片全身麻醉的安全性与有效性研究OA

Objective To investigate the safety,efficacy,and impact of esketamine on postoperative cognitive function in elderly patients undergoing surgical treatment for femoral fractures under opioid-free anesthesia.Methods A total of 60 elderly patients who underwent elective closed reduction and internal fixation for femoral fractures at the Second People's Hospital of Changshu City from January 2023 to June 2024 were selected as subjects.The patients were randomly assigned to control group(n=30)and experimental group(n=30)using a random number table.Both groups received ultrasound-guided iliac fascia block under general anesthesia.The control group was induced with fentanyl+etomidate+rocuronium,with maintenance of anesthesia using remifentanil+propofol infusion.The experimental group was induced with eszopiclone+etomidate+rocuronium,with maintenance of anesthesia using esketamine+propofol infusion.Heart rate(HR),mean arterial pressure(MAP),and bispectral index(BIS)were recorded before induction(T0),the axter induetion(T1),at the incision site(T2),and before surgical completion(T3).Postoperative visual analogue scale(VAS)scores at 30 minutes and 24 hours,preoperative and postoperative 24-hour mini-mental state examination(MMSE)scores,and postoperative adverse reactions were compared between two groups.Results At time point T1,MAP and HR in experimental group were higher than those in control group(P<0.05).At all time points from T1 to T3,MAP and HR in both groups were lower than those at T0(P<0.05).The extubation time in experimental group was shorter than that in control group(P<0.05).The 24-hour MMSE scores were lower in both groups postoperatively compared to preoperative levels,with experimental group showing higher MMSE scores at 24 hours than control group(P<0.05).No statistically significant difference was observed in the incidence of adverse reactions between two groups(P>0.05).Conclusion In surgical treatment of senile femoral fractures,the esketamine-based desialpine anesthesia regimen demonstrates excellent safety profiles,mitigates hemodynamic fluctuations during induction,reduces extubation time,and improves postoperative cognitive function within 24 hours.