亚麻醉剂量氯胺酮对老年患者全髋关节置换术后认知功能障碍的影响

Effects of Ketamine on Postoperative Cognitive Dysfunction in Elderly Patients after Total hip Arthroplasty

目的:探讨亚麻醉剂量氯胺酮对老年患者全髋关节置换术后认知功能障碍的影响。方法:以在我院行全髋关节置换术的60例老年患者为研究对象,将患者按照随机分组的原则分为氯胺酮组和对照组,氯胺酮组30例给予亚麻醉剂量氯胺酮治疗,对照组则给予相同体积的生理盐水。两组患者均分别于术前1d、术后1h、24h、48h、72h时采集静脉血用放射免疫法检查IL-6,TNF-α浓度,应用简易智能状态检查量表(MMSE)评价两组患者术前1d、术后24h、48h、72h的认知功能状况。结果:氯胺酮组和对照组患者在术前1d血清IL-6、TNF-α浓度、MMSE评分比较无显著差异(P>0.05)。氯胺酮组患者术后1h、24h、48h、72h血清IL-6、TNF-α升高程度低于对照组,差异具有统计学意义(P<0.05)。氯胺酮组术后24h、48h、72h术后认知功能障碍(Postoperative Cognitive Dysfunction,POCD)发生率低于对照组,差异具有统计学意义(P<0.05)。结论:行全髋关节置换术的老年患者运用亚麻醉剂量氯胺酮可有效减少术后认知障碍的发生率,推测可能与氯胺酮的抗炎性反应有关。

Objective To investigate the effect of ketamine on postoperative cognitive dysfunction in elderly patients after total hip arthroplasty.Methods： 60 cases of elderly patients underwent total hip arthroplasty were chosen as the object of study, the patients were randomized divided intoketamine group and control group. Ketamine group （30 cases） was treated with sub anaesthetic doses of ketamine treatment, and control group wasgiven the same volume of saline. Venous blood in the two groups of patients were collected in the preoperative 1day, postoperative 1h, 24h, 48h,72h and then examination of IL-6 with radioimmunoassay. Concentrations of TNF alpha were also measured. And mini mental state examinationapplication amount table evaluation （MMSE） were performed in two groups of patients 1 day before operation, and postoperative 24h, 48h, 72h.Results： There was no significant difference in the serum IL-6, TNF- alpha and MMSE scores between the two groups before and after the operationin the ketamine group and the control group （P〉0.05）. The level of 1h, 24h, 48h, 72h, IL-6 and TNF- alpha were lower than the control group, thedifference was statistically significant （P〈0.05）. The incidence of postoperative cognitive dysfunction （POCD） in ketamine group was lower than thatin control group after 24h, 48h and 72h, and it was statistically significant （P〈0.05）. Conclusion： The use of ketamine in elderly patients with totalhip arthroplasty can effectively reduce the incidence of postoperative cognitive impairment, which may be related to the anti-inflammatory effect ofketamine.