Altern Ther Health Med. 2024 Mar;30(3):80-85.
Our aim was to evauate the application value of esesketamine and dexmedetomidine in preventing postoperative hyperalgesia in elderly patients who received thoracic anesthesia.
A total of 94 elderly patients who underwent thoracic anesthesia in Sanmen People's Hospital from January 2021 to October 2022 were selected and divided into a dexmedetomidine group (n = 47) and an esketamine group (n = 47) by the random number table method. All patients were continuously received intravenous (IV) remifentanil. In the dexmedetomidine group, dexmedetomidine 0.7 μg/kg was administered IV, followed by 0.2 to 0.5 μg/kg/h to maintain anesthesia, while in the esketamine group, esketamine 0.5 mg/kg was given IV 20 min after induction of anesthesia was completed.
Visual analogue scale (VAS) scores in the esketamine group were lower than in the dexmedetomidine group at 1, 6, 12 and 24 h postoperatively (P < .05), and Ramsay sedation scores were not statistically different from those in the dexmedetomidine group (P > .05). At 3 d postoperatively, the Mini-Mental State Examination (MMSE) scores in the dexmedetomidine group were lower than 1 d preoperatively; at 5 d postoperatively, the negative mood and Pittsburgh Sleep Quality Index (PSQI) scores were significantly higher in both groups than 1 d preoperatively; at 14 d postoperatively, the PSQI scores were higher in both groups than 1 d preoperatively, and there was no statistical difference between the negative mood scores at 1 d before surgery (P > .05). At 5 d postoperatively in the esketamine group, the negative mood scores were lower than in the dexmedetomidine group at 5 d postoperatively and the PSQI scores at 5 and 14 d postoperatively were lower than in the dexmedetomidine group (P < .05).
Both esketamine and dexmedetomidine can be used to prevent postoperative delirium and nociceptive hypersensitivity after anesthesia in elderly patients with thoracic surgery. However, esketamine is superior to dexmedetomidine in analgesic effect, improvement of negative mood and sleep and stabilization of intraoperative hemodynamics, leading to better effect in preventing delirium and hyperalgesia after anesthesia.
评估右美托咪定和依托咪酯在预防接受胸麻醉的老年患者术后痛觉过敏中的应用价值。
选取 2021 年 1 月至 2022 年 10 月三门县人民医院收治的 94 例行胸麻醉的老年患者，采用随机数字表法分为右美托咪定组（n = 47）和依托咪酯组（n = 47）。所有患者均持续静脉输注瑞芬太尼。右美托咪定组静脉注射右美托咪定 0.7 μg/kg，然后以 0.2 至 0.5 μg/kg/h 维持麻醉，依托咪酯组则在麻醉诱导完成后 20 分钟时静脉注射依托咪酯 0.5 mg/kg。
术后 1、6、12 和 24 小时，依托咪酯组的视觉模拟评分（VAS）均低于右美托咪定组（P <.05），而 Ramsay 镇静评分与右美托咪定组无统计学差异（P >.05）。术后 3 天，右美托咪定组的简易精神状态检查（MMSE）评分低于术前 1 天；术后 5 天，两组的负性情绪和匹兹堡睡眠质量指数（PSQI）评分均明显高于术前 1 天；术后 14 天，两组的 PSQI 评分均高于术前 1 天，而术前 1 天的负性情绪评分无统计学差异（P >.05）。术后 5 天，依托咪酯组的负性情绪评分低于右美托咪定组，PSQI 评分在术后 5 天和 14 天均低于右美托咪定组（P <.05）。
右美托咪定和依托咪酯均可用于预防老年胸外科手术患者麻醉后谵妄和伤害性感觉过敏。然而，依托咪酯在镇痛效果、改善负性情绪和睡眠、稳定术中血流动力学方面优于右美托咪定，在预防麻醉后谵妄和痛觉过敏方面效果更好。
