小剂量艾司氯胺酮对老年髋骨折患者术后早期认知功能的影响

Effects of low-dose esketamine on early postoperative cognitive function in elderly patients with hip fracture

目的观察小剂量艾司氯胺酮对髋骨折老年患者术后早期认知功能及S100β蛋白的影响。方法将60例拟在椎管内麻醉下行髋骨折手术的老年患者随机均分为2组,麻醉穿刺前15 min试验组给予艾司氯胺酮0.25 mg·kg^(-1)静脉注射,对照组给予等量氯化钠注射液。2组其他麻醉方案相同。观察患者生命体征变化,术前和术后1、2、3 d评估简易精神状态检查(MMSE)评分,检测血S100β蛋白浓度,并记录术后认知功能障碍(POCD)发生情况。结果2组患者平均动脉压(MAP)和心率(HR)均较平稳,麻醉穿刺时、手术开始时试验组MAP、HR均显著低于对照组(P<0.05)。与术前相比,2组术后MMSE评分均显著下降(P<0.05),术后1、2、3 d试验组MMSE评分均高于对照组,差异有显著意义(P<0.05)。术后2、3 d,试验组POCD发生率显著低于对照组(P<0.05)。2组术后S100β蛋白水平均较术前显著上升(P<0.05),术后1、2、3 d试验组S100β蛋白水平显著低于对照组(P<0.05)。结论艾司氯胺酮0.25 mg·kg^(-1)可减少髋骨折老年患者POCD的发生,可能与降低S100β蛋白水平有关。

AIM To observe the effects of low-dose esketamine on early postoperative cognitive function and S100βprotein in elderly patients with hip fracture.METHODS Sixty elderly patients undergoing hip fracture surgery under spinal anesthesia were randomly divided into two groups.The trial group(n=30)was given esketamine 0.25 mg·kg^(-1)intravenously 15 minutes before anesthesia puncture,and the control group(n=30)was given the same amount of sodium chloride injection.The other anesthesia protocols in the two groups were the same.The changes of vital signs of the patients were observed,the scores of the mini-mental state examination(MMSE)were evaluated before and 1,2,and 3 days after the operation,the blood S100βprotein concentration was detected,and the occurrence of postoperative cognitive dysfunction(POCD)was recorded.RESULTS The mean arterial pressure(MAP)and heart rate(HR)of patients in the two groups were relatively stable.The MAP and HR of the trial group were significantly lower than those of the control group during anesthesia puncture and at the beginning of the operation(P<0.05).Compared with preoperative,postoperative MMSE scores of both groups were significantly decreased(P<0.05).The MMSE scores of the trial group were higher than those of the control group 1,2,and 3 days after operation,and the difference was significant(P<0.05).At 2 and 3 days after operation,the incidence of POCD in the trial group was significantly lower than that in the control group(P<0.05).The levels of S100βin both groups after operation were significantly higher than those before operation(P<0.05),and the levels of S100βin the trial group were lower than those in the control group 1,2,and 3 days after operation,with significant differences(P<0.05).CONCLUSION Esketamine 0.25 mg·kg^(-1) can reduce the occurrence of POCD in elderly patients with hip fracture,which may be related to the reduction of S100βlevel.