依托咪酯联合小剂量艾司氯胺酮用于老年全髋关节置换术麻醉诱导时的效果分析

doi:10.3969/j.issn.1003-9198.2026.02.006

摘要/Abstract

摘要： 目的分析依托咪酯联合小剂量艾司氯胺酮用于老年全髋关节置换术麻醉诱导时的效果。方法前瞻性选择2021年4月至2024年3月上海大学附属南通医院(南通市第六人民医院)收治的老年全髋关节置换术患者85例,根据麻醉方法将其分为观察组(44例,麻醉诱导时注射依托咪酯0.2 mg/kg、舒芬太尼0.4 μg/kg及艾司氯胺酮0.2 mg/kg)、对照组(41例,麻醉诱导时注射依托咪酯0.2 mg/kg、舒芬太尼0.4 μg/kg及与艾司氯胺酮等体积的生理盐水)。对比2组血流动力学、血压水平、术后疼痛程度、麻醉诱导期间不良反应与并发症的发生情况。结果麻醉诱导后3 min(T1)、麻醉诱导后5 min(T2)时,2组平均动脉压(MAP)、心率(HR)、SBP、DBP均较麻醉诱导前显著下降(P＜0.05),但观察组上述指标水平均高于对照组(P＜0.05);T2时刻,2组MAP、HR、SBP、DBP均较T1时刻有所回升(P＜0.05)。2组术后12、24 h的VAS评分均显著低于术后2 h(P＜0.05);术后24 h,2组VAS评分低于术后12 h(P＜0.05);观察组术后2、12、24 h的VAS评分均低于对照组(P＜0.05)。2组高血压、心动过速、肌痉挛、心动过缓的发生率差异无统计学意义(P＞0.05),观察组低血压及呛咳发生率显著低于对照组(P＜0.05)。结论依托咪酯联合小剂量艾司氯胺酮用于老年全髋关节置换术中镇痛效果确切,可减轻术后疼痛,维持术中血流动力学稳定,血压更平稳,且可降低呛咳、低血压的发生风险。

关键词: 依托咪酯, 艾司氯胺酮, 老年人, 全髋关节置换术, 血流动力学

Abstract: Objective To analyze the effect of etomidate combined with low dose esketamine in anesthesia induction in the elderly patients undergoing total hip replacement. Methods A total of 85 elderly patients who underwent total hip arthroplasty at Affiliated Nantong Hospital Of Shanghai University (The Sixth People’s Hospital of Nantong) from April 2021 to March 2024 were prospectively selected. According to the anesthesia methods, they were divided into an observation group (44 cases, receiving etomidate 0.2 mg/kg, sufentanil 0.4 μg/kg, and esketamine 0.2 mg/kg during anesthesia induction) and a control group (41 cases, receiving etomidate 0.2 mg/kg, sufentanil 0.4 μg/kg, and an equal volume of normal saline instead of esketamine during anesthesia induction). The hemodynamics, blood pressure levels, postoperative pain degrees, adverse reactions and complications during anesthesia induction were compared between the two groups. Results At the time of 3 minutes (T1) and 5 minutes (T2) after anesthesia induction, the mean arterial pressure (MAP), heart rate (HR), systolic blood pressure (SBP), and diastolic blood pressure (DBP) in both groups were significantly lower than those before anesthesia induction (P<0.05), but the levels of these indicators in the observation group were higher than those in the control group (P<0.05). At T2, the levels of MAP, HR, SBP and DBP in both groups increased significantly compared to those at T1 (P<0.05). The Visual Analogue Scale (VAS) scores 12 and 24 hours after operation were significantly lower than those 2 hours after operation in both groups (P<0.05). Twenty-four hours after operation, the VAS scores of both groups were lower than those 12 hours after operation(P<0.05). The VAS scores of the observation group 2, 12, and 24 hours after operation were lower than those of the control group (P<0.05). There were no differences in the incidence rates of hypertension, tachycardia, muscle spasm and bradycardia between the two groups (P>0.05), and the incidence rates of hypotension and cough in the observation group were lower than those in the control group (P<0.05). Conclusions Etomidate combined with low-dose esketamine has a definite analgesic effect in elderly patients undergoing total hip replacement, which can reduce postoperative pain, maintain stable intraoperative hemodynamics, stable blood pressure, and reduce the risk of cough and hypotension.

Key words: etomidate, esketamine, aged, total hip arthroplasty, hemodynamics

中图分类号:

刘蓓丽, 陈永红, 叶帅, 张斌, 夏晴, 宋炳炎, 朱俊勇, 季红霞, 吴娟, 孟琦, 徐夏迟. 依托咪酯联合小剂量艾司氯胺酮用于老年全髋关节置换术麻醉诱导时的效果分析[J]. 实用老年医学, 2026, 40(2): 132-135.

LIU Beili, CHEN Yonghong, YE Shuai, ZHANG Bin, XIA Qing, SONG Bingyan, ZHU Junyong, JI Hongxia, WU Juan, MENG Qi, XU Xiachi. Effect analysis of etomidate combined with low dose esketamine in anesthesia induction of total hip arthroplasty in elderly patients[J]. Practical Geriatrics, 2026, 40(2): 132-135.

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