低剂量艾司氯胺酮对老年患者在全麻下行胃肠道肿瘤切除术的术后神经认知功能障碍的影响：一项随机对照试验

以下文章来源于罂粟花 ，作者anesthGH

本文由“罂粟花”授权转载

低剂量艾司氯胺酮对老年患者在全麻下行胃肠道肿瘤切除术的术后神经认知功能障碍的影响：一项随机对照试验

贵州医科大学  麻醉与心脏电生理课题

翻译:  马艳燕

编辑:  严旭

审校: 曹莹

目的：

本研究旨在观察术中应用小剂量艾司氯胺酮对老年患者在全麻下行胃肠道肿瘤切除术的术后神经认知功能障碍(PND)的影响。

方法：

68名老年患者随机分为两组：艾司氯胺酮组(Es组)(负荷0.25mg/kg，静脉输注0.125mg/kg/h)和对照组(C组)(接受生理盐水)。主要结局是延迟神经认知恢复（DNR）的发生率。次要结局包括术中出血量；手术期间给予的液体总量；丙泊酚和瑞芬太尼的消耗量；心血管不良事件；血管活性药物的使用；手术和麻醉时间；舒芬太尼补救性镇痛的例数；术后谵妄（POD）的发生率；术中血流动力学；术后0、1、2小时的脑电双频指数（BIS）值和术后3天内的数字评定量表（NRS）疼痛评分。

结果：

Es组DNR发生率(16.13%)低于C组（38.71%)(P ＜0.05)。Es组术中瑞芬太尼剂使用量和使用多巴胺的病例数均低于C组(P＜0.05)。与C组相比，Es组插管后3分钟DBP较高，拔管后30分钟时MAP较低(P＜0.05)。Es组低血压和心动过速发生率低于C组(P＜0.05)。Es组术后3天NRS疼痛评分低于C组(P＜0.05)。

结论：

低剂量艾司氯胺酮输注在一定程度上降低了老年患者在全麻下行胃肠道肿瘤切除术后DNR的发生率，改善术中血流动力学和BIS值，降低心血管不良事件的发生率和术中阿片类药物的消耗量，缓解术后疼痛。

原始文献来源：

Ma J, Wang F, Wang J, Wang P, Dou X, Yao S, Lin Y. The Effect of Low-Dose Esketamine on Postoperative Neurocognitive Dysfunction in Elderly Patients Undergoing General Anesthesia for Gastrointestinal Tumors: A Randomized Controlled Trial. Drug Des Devel Ther. 2023 Jun 29;17:1945-1957. doi: 10.2147/DDDT.S406568. 

英文原文：

The Effect of Low-Dose Esketamine on Postoperative Neurocognitive Dysfunction in Elderly Patients Undergoing General Anesthesia for Gastrointestinal Tumors: A Randomized Controlled Trial

Purpose: This study aims to evaluate the effects of the intraoperative application of low-dose esketamine on postoperative neurocognitive dysfunction (PND) in elderly patients undergoing general anesthesia for gastrointestinal tumors.

Methods: Sixty-eight elderly patients were randomly allocated to two groups: the esketamine group (group Es) (0.25 mg/kg loading, 0.125mg/kg/h infusion) and the control group (group C) (received normal saline). The primary outcome was the incidence of delayed neurocognitive recovery (DNR). The secondary outcomes were intraoperative blood loss, the total amount of fluid given during surgery, propofol and remifentanil consumption, cardiovascular adverse events, use of vasoactive drugs, operating and anesthesia time, the number of cases of sufentanil remedial analgesia, the incidence of postoperative delirium (POD), the intraoperative hemodynamics, bispectral index (BIS) value at 0, 1, 2 h after operation and numeric rating scale (NRS) pain scores within 3 d after surgery.

Results: The incidence of DNR in group Es (16.13%) was lower than in group C (38.71%) (P < 0.05). The intraoperative remifentanil dosage and the number of cases of dopamine used in group Es were lower than in group C (P < 0.05). Compared with group C, DBP was higher at 3 min after intubation, and MAP was lower at 30 min after extubation in group Es (P< 0.05). The incidence of hypotension and tachycardia in group Es was lower than in group C (P < 0.05). The NRS pain score at 3 d after surgery in group Es was lower than in group C (P < 0.05).

Conclusion: Low-dose esketamine infusion reduced to some extent the incidence of DNR in elderly patients undergoing general anesthesia for gastrointestinal tumors, improved intraoperative hemodynamics and BIS value, decreased the incidence of cardiovascular adverse events and the intraoperative consumption of opioids, and relieved postoperative pain.

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编辑：Michel.米萱

校对：MiLu.米鹭

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