艾司氯胺酮对行膝关节置换术的老年患者术后早期认知功能的影响

Effect of esketamine on early postoperative cognitive function in elderly patients undergoing knee replacement

目的探讨艾司氯胺酮对行膝关节置换术的老年患者术后早期认知功能的影响。方法行膝关节置换术的老年患者60例随机均分为两组。A组于切皮前静脉注射艾司氯胺酮0.5 mg/kg,术中持续静脉泵注艾司氯胺酮0.4 mg·kg^(-1)·h^(-1)至术毕前20 min。C组在相同时间点注射等剂量生理盐水。采用蒙特利尔认知评估量表(MoCA)评分评估两组术前1 d(T1)和术后第1(T2)、3(T3)、5(T4)天认知功能和围术期神经认知紊乱(PND)发生率。采用数字疼痛评分(NRS)评估两组术后2(S1)、4(S2)、12(S3)、24 h(S4)患者疼痛情况。采用ELISA法检测两组T1~T4时血清IL-6和S100β水平。观察两组术后不良反应。结果A组T2和T3时MoCA评分高于C组(P<0.01)。A组PND发生率低于C组(6.67%vs.26.67%)(P<0.01)。A组术中丙泊酚和瑞芬太尼用量少于C组(P<0.01)。A组S1~S3时NRS评分均低于C组(P<0.01)。A组T2和T3时血清IL-6和S100β水平低于C组(P<0.01)。两组术后不良反应发生率相仿(P>0.05)。结论艾司氯胺酮可改善行膝关节置换术老年患者术后早期认知功能,且无明显不良反应。

Objective To investigate the effect of esketamine on early postoperative cognitive function in elderly patients undergoing knee replacement.Methods Sixty elderly patients undergoing knee replacement were randomly divided into two groups,with 30 cases each.Group A was intravenously injected with esketamine 0.5 mg/kg before incision,which was fillowed by intravenous infussion of esketamine 0.4 mg·kg^(-1)·h^(-1)until 20 minutes before the end of operation.Normal saline instead of esketamine was used in group C.The cognitive function was evaluated with Montreal Cognitive Assessment(MoCA)score at the time points of one day before surgery(T1)and the 1st(T2),3rd(T3)and 5th(T4)day after surgery.The incidence of perioperative neurocognitive disorders(PND)was calculated.Numeric Rating Scales(NRS)was used to evaluate the pain of 2(S1),4(S2),12(S3),24 hours(S4)after surgery.Serum levels of IL-6 and S100βwere detected by ELISA at T1-T4.Postoperative adverse reactions were observed as well.Results MoCA scores at T2 and T3 were higher in group A than those in group C(P<0.01).The incidence of PND was lower in group A than that in group C(6.67%vs.26.67%)(P<0.01).The consumption of propofol and remifentanil during operation was less in group A than that in group C(P<0.01).NRS scores at S1-S3 in group A were lower than those in group C(P<0.01).Serum levels of IL-6 and S100βin group A were lower than those in group C at T2 and T3(P<0.01).The incidences of postoperative adverse reactions of two groups were similar(P>0.05).Conclusion Esketamine can improve postoperative cognitive function in elderly patients undergoing knee replacement without obvious adverse reactions.