亚麻醉剂量艾司氯胺酮对老年患者胸腔镜肺叶楔形切除术后认知功能的影响

The effects of subanesthetic dose of esketamine on cognitive function in elderly patients after thoracoscopic wedge lobectomy surgery

目的探讨亚麻醉剂量艾司氯胺酮对老年患者胸腔镜肺叶楔形切除术后恢复及认知功能的影响。方法选择120例择期全麻下行胸腔镜肺叶楔形切除术患者,随机数字表法分为艾司氯胺酮组(ES组)和对照组(C组)。ES组患者在全麻诱导开始前5 min时静脉注射0.1 mg/kg艾司氯胺酮,C组患者给予等量生理盐水,术中及术后两组患者麻醉和镇痛方案相同,比较两组患者术中一般情况,术后恢复情况(苏醒时间、术后拔管时间、定向力恢复时间)、术前及术后不同时间段简易精神状态量表(MMSE),炎症因子血清白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)水平。结果两组患者手术时间、术中出血量、血压及血氧饱和度等术中一般情况比较,差异无统计学意义(P>0.05);ES组苏醒时间、术后拔管时间及定向力恢复时间均早于C组(P<0.05);拔管后6 h、1 d、3 d,两组MMSE评分均低于术前,ES组MMSE评分高于C组(P<0.05);术后1、3d ES组患者血清IL-6、TNF-α水平低于C组(P<0.05)。结论麻醉诱导前单次静注亚麻醉剂量艾司氯胺酮能有效缩短术后恢复时间,且对患者认知功能影响较小,安全性更高。

Objective To explore the effects of subanesthetic dose of esketamine on the recovery and cognitive function in elderly patients undergoing thoracoscopic wedge lobectomy surgery.Methods One hundred and twenty elderly patients undergoing selective thoracoscopic wedge lobectomy under general anesthesia were selected.The patients were divided into an esketamine group(ES group)and a control group(C group)by using random number table method.The ES group was given 0.1 mg/kg of esketamine before 5 minutes of start of general anesthesia.The C group was given an equal amount of physiological saline.The same intraoperative anesthesia scheme and postoperative analgesia methods were performed in both groups.The general conditions during the surgery of the two groups,the postoperative recovery states such as recovery time,extubation time and directional force recovery time,mini mental state examination(MMSE)at different time periods before and after the operation,and the level of inflammatory factors such as serum interleukin-6(IL-6)and tumor necrosis factor(TNF)-αwere compared between the two groups.Results There was no significant difference in the operation time,blood loss,blood pressure and blood oxygen between the two groups(P>0.05).The recovery time of awakening,extubation time and directional force time in the ES group was earlier than that in the C group(P<0.05).After 6 hours,1 day and 3 days of extubation,the MMSE scores in both groups were lower than those before operation,while those in the ES group were higher than those in the C group(P<0.05).The serum levels of IL-6 and TNF-αin the ES group were lower than those in the C group(P<0.05).Conclusions Before induction of anesthesia,a single intravenous injection of a subanesthetic dose of esketamine can effectively shorten the postoperative recovery time with less influence on patients'cognitive function.Its safety is high.