低剂量艾司氯胺酮对全麻老年患者术后神经认知功能障碍的影响

以下文章来源于小麻哥的日常 ，作者两只小绵羊

本文由“小麻哥的日常”授权转载  

摘要译文（供参考）  

低剂量艾司氯胺酮对全麻老年胃肠道肿瘤患者术后神经认知功能障碍的影响：一项随机对照试验

目的：  

本研究旨在评估术中应用低剂量艾司氯胺酮对老年胃肠道肿瘤全身麻醉患者术后神经认知功能障碍（postoperative neurocognitive dysfunction，PND）的影响。

方法：  

68例老年患者随机分为艾司氯胺酮组（Es组）（负荷剂量25.0mg/kg，维持剂量125.0mg/kg/h静脉输注）和对照组（C组）（接受相同量的生理盐水）。主要结局指标是神经认知功能恢复延迟（delayed neurocognitive recovery，DNR）的发生率。次要结局指标是术中失血量、手术期间给予的液体总量、丙泊酚和瑞芬太尼的消耗、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病例数、术后谵妄（postoperative delirium，POD）的发生率、术中血流动力学、术后1、2、3小时的脑电双频指数（bispectral index，BIS）值和术后3天内的数字评定量表（numeric rating scale，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组术中瑞芬太尼用量和多巴胺使用病例数均低于C组（P <0.05）。

与C组相比，Es组插管后3 min 的DBP升高，拔管后30 min的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）。

E组术后3天的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胃肠道肿瘤全麻患者DNR的发生率，改善了术中血流动力学和BIS值，降低了心血管不良事件的发生率和术中阿片类药物的消耗，缓解了术后疼痛。

关键词：  

老年患者;艾司氯胺酮;胃肠道手术;术后神经认知功能障碍。

原文摘要  

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.

Keywords:elderly patients; esketamine; gastrointestinal surgery; postoperative neurocognitive dysfunction.

Figure 1. Flowchart of the study design.  

Figure 2. Comparison of hemodynamic indexes between the two groups. (A). SBP; (B). DBP; (C). MAP; (D). HR.  

Figure 3. Comparison of MMSE scores between the two groups.  

Figure 4. Comparison of the incidence of DNR between the two groups.  

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本公众平台所刊载原创或转载内容不代表米勒之声的观点或立场。文中所涉及药物使用、疾病诊疗等内容仅供医学专业人士参考。

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编辑：Michel.米萱

校对：MiSuper.米超

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