艾司氯胺酮对全身麻醉老年患者术后谵妄的影响

Effect of esketamine on postoperative delirium in elderly patients undergoing general anesthesia

目的:评价艾司氯胺酮对全身麻醉老年患者术后谵妄(POD)的影响。方法:择期全身麻醉下手术老年患者224例,性别不限,年龄≥65岁,ASA分级Ⅰ~Ⅲ级,采用随机数字表法分为2组(n=112):艾司氯胺酮组(S组)和对照组(C组)。S组于麻醉诱导前静脉注射艾司氯胺酮0.5 mg/kg,C组注射等体积生理盐水。采用意识模糊评估量表(3D-CAM)评估患者术后7 d内POD的发生情况,记录术中丙泊酚、瑞芬太尼、舒芬太尼用量及血管活性药物使用情况,记录术后48 h内补救镇痛情况及术后并发症的发生情况。结果:与C组比较,S组POD发生率降低,术中瑞芬太尼用量减少,术中血管活性药物使用率、术后48 h内补救镇痛率以及术后眩晕、恶心呕吐发生率降低(P<0.05)。结论:艾司氯胺酮可降低全身麻醉老年患者POD的发生。

Objective To evaluate the effect of esketamine on postoperative delirium(POD)in elderly patients undergoing general anesthesia.Methods Two hundred and twenty-four elderly patients,aged≥65 yr,with American Society of Anesthesiologists Physical Status classificationⅠ-Ⅲ,undergoing elective surgery under general anesthesia,were divided into 2 groups(n=112 each)using a random number table method:esketamine group(S group)and control group(C group).Esketamine 0.5 mg/kg was intravenously injected before anesthesia induction in S group,while the equal volume of normal saline was given instead in C group.The Fuzzy Consciousness Assessment Scale(3D-CAM)was used to assess the occurrence of POD within 7 days after surgery.The consumption of propofol,remifentanil and sufentanil and use of vasoactive drugs were recorded during operation.The rescue analgesia within 48 h after operation and occurrence of postoperative complications were recorded.Results Compared with C group,the incidence of POD was significantly decreased,the intraoperative consumption of remifentanil was reduced,and the utilization rate of vasoactive drugs,rate of rescue analgesia and incidence of postoperative vertigo,nausea and vomiting within 48 h after surgery were decreased in S group(P<0.05).Conclusions Esketamine can reduce the development of POD in elderly patients.