2025 年第 8 期 第 20 卷

艾司氯胺酮联合酒石酸布托啡诺对股骨颈骨折行全髋关节置换术老年患者疼痛介质水平和炎症应激反应的影响

The effects of esmketamine combined with butorphanol tartrate on pain mediators and inflammatory stress response in elderly patients with femoral neck fracture undergoing total hip replacement

作者：李星辉张碧凤赵薇

英文作者：Li Xinghui Zhang Bifeng Zhao Wei

单位：贵州中医药大学第二附属医院麻醉科，贵阳550003

英文单位：Department of Anesthesiology the Second Affiliated Hospital of Guizhou University of Traditional Chinese Medicine Guiyang 550003 China

关键词：股骨颈骨折；全髋关节置换术；艾司氯胺酮；酒石酸布托啡诺；疼痛介质；应激反应；炎症因子

英文关键词：Femoralneckfracture;Totalhiparthroplasty;Esmketamine;Butorphanoltartrate;Painmediators;Stressresponse;Inflammatoryfactors

• 摘要：

• 目的 探讨艾司氯胺酮联合酒石酸布托啡诺对股骨颈骨折行全髋关节置换术老年患者疼痛介质水平和炎症应激反应的影响。方法 选取2022年9月至2024年9月贵州中医药大学第二附属医院收治的112例股骨颈骨折行全髋关节置换术老年患者为研究对象。采用随机数字表法将112例患者分为观察组和对照组，每组56例。对照组术后给予酒石酸布托啡诺自控静脉镇痛，观察组采取艾司氯胺酮联合酒石酸布托啡诺自控静脉镇痛。比较2组患者术后镇痛、镇静评分，疼痛介质、炎症因子、应激反应指标水平，以及不良反应总发生率。结果  2组术后2、6、12、24 h的视觉模拟量表评分均逐渐降低且观察组各时点均低于对照组，Ramsay镇静评分均逐渐升高且观察组各时点均高于对照组（均P<0.001）。术后24 h 2组前列腺素E2、P物质及β-内啡肽水平均高于术前，但观察组均低于对照组［（49±6）μg/L比（52±5）μg/L、（61±6）μg/L比（65±6）μg/L、（130±13）μg/L比（138±15）μg/L］（均P<0.05）。术后24 h 2组肿瘤坏死因子α、白细胞介素6、肾上腺素、去甲肾上腺素及皮质醇均高于术前，但观察组低于对照组；白细胞介素10均低于术前，但观察组高于对照组（均P<0.05）。2组不良反应总发生率比较差异无统计学意义（P>0.05）。结论  艾司氯胺酮联合酒石酸布托啡诺术后镇痛对股骨颈骨折行全髋关节置换术老年患者镇痛镇静效果良好，可降低疼痛介质及TNF-α、IL-6水平，升高IL-10水平，减轻应激反应。

• Objective To investigate the effects of esmketamine combined with butorphanol tartrate on pain mediators and inflammatory stress response in elderly patients with femoral neck fracture undergoing total hip replacement. Methods A total of 112 elderly patients with femoral neck fracture who underwent total hip arthroplasty in the Second Affiliated Hospital of Guizhou University of Traditional Chinese Medicine from September 2022 to September 2024 were selected as the research objects. A total of 112 patients were divided into observation group and control group by random number table method, with 56 cases in each group. The control group was given butorphanol tartrate patient-controlled intravenous analgesia, while the observation group was given esketamine combined with butorphanol tartrate patient-controlled intravenous analgesia. The postoperative analgesia and sedation scores, pain mediators, inflammatory factors, stress response and the total incidence of adverse reactions were compared between the two groups. Results The Visual Analogue Scale scores of the two groups at 2, 6, 12 and 24 h after operation were gradually decreased, and those in the observation group were lower than those in the control group at each time point. The Ramsay sedation scores of the observation group were gradually increased, and those in the observation group were higher than those in the control group at each time point (all P<0.001). The levels of prostaglandin E2, substance P, and β-endorphin in the two groups 24 h after operation were higher than those before operation, but those in the observation group were lower than those in the control group ［(49±6)μg/L vs (52±5)μg/L, (61±6)μg/L vs (65±6)μg/L, (130±13) μg/L vs (138±15)μg/L］(all P<0.05). The levels of tumor necrosis factor-α, interleukin-6, epinephrine, norepinephrine and cortisol in the two groups at 24 h after operation were higher than those before operation, but those in the observation group were lower than those in the control group. The level of interleukin-10 in the observation group was higher than that in the control group (all P<0.05). There was no significant difference in the total incidence of adverse reactions between the two groups (P>0.05). Conclusion Esmketamine combined with butorphanol tartrate has a good analgesic and sedative effect on elderly patients with femoral neck fracture undergoing total hip replacement. It can reduce the levels of pain mediator, tumor necrosis factor-α and interleukin-6, increase the level of interleukin-10, and reduce the stress response.