小剂量艾司氯胺酮对非心脏手术老年患者术后认知功能的影响

Effect of low-dose esketamine on postoperative cognitive function in elderly patients undergoing non-cardiac surgery

目的评价小剂量艾司氯胺酮对非心脏手术老年患者术后认知功能的影响。方法择期全身麻醉下行非心脏手术患者124例,年龄65~80岁,性别不限,BMI 18~35 kg/m2,ASA分级Ⅰ或Ⅱ级,采用随机数字表法分为艾司氯胺酮组(E组,n=64)和对照组(C组,n=60)。E组静脉注射艾司氯胺酮0.5 mg/kg,C组静脉注射等容量生理盐水,2组静脉注射芬太尼、丙泊酚和罗库溴铵行麻醉诱导;采用静吸复合麻醉进行维持;术后行PCIA。分别于术前1 d和术后30 d行简易精神状态检查、听觉词语学习测试、循迹连线测验A版和B版、数字符号替换测试、波士顿命名测试、复杂图形测试,采用Z计分法判断术后认知功能障碍发生情况。术后1~7 d采用意识模糊评估法评估谵妄发生情况。记录术中低血压和术后苏醒延迟、恶心呕吐、幻觉等发生情况。记录自主呼吸恢复时间、呼唤睁眼时间和气管拔管时间。结果与C组相比,E组术后30 d时认知功能障碍发生率和术中低血压发生率降低(P<0.05),自主呼吸恢复时间、呼唤睁眼时间、气管拔管时间、术后苏醒延迟、谵妄、幻觉、恶心呕吐发生率差异无统计学意义(P>0.05)。结论小剂量艾司氯胺酮可改善非心脏手术老年患者术后认知功能。

Objective To assess the effect of low-dose esketamine on postoperative cognitive function in elderly patients undergoing non-cardiac surgery.Methods One hundred and twenty-four patients,aged 65-80 yr,regardless of gender,with a body mass index of 18-35 kg/m2,of American Society of Anesthesiologists Physical Status classificationⅠorⅡ,were assigned to either esketamine group(group E,n=64)or control group(group C,n=60)using a random number table method.Group E received intravenous esketamine at a dose of 0.5 mg/kg,while group C received an equal volume of normal saline intravenously.Anesthesia was induced with intravenous fentanyl,propofol and rocuronium and maintained using combined intravenous-inhalational anesthesia in both groups.Patient-controlled analgesia was carried out postoperatively.Cognitive function tests including a simple mental state examination,auditory word learning test,tracking connection test A and B,number symbol replacement test,Boston naming test and complex graph test were performed at 1 day before surgery and 30 days after surgery,and postoperative cognitive dysfunction was determined using Z-score method.Delirium was assessed using Confusion Assessment Method from 1 to 7 days after operation.The operative hypotension,postoperative delayed emergence,nausea and vomiting,and hallucinations were recorded.The recovery time of spontaneous breathing,eye opening to verbal command and extubation time were recorded.Results Compared with group C,the incidence of cognitive dysfunction at 30 days after surgery and intraoperative hypotension was significantly decreased(P<0.05),and no significant change was found in the recovery time of spontaneous breathing,eye opening to verbal command,extubation time,incidence of postoperative delayed emergence,delirium,nausea and vomiting,and hallucinations in group E(P>0.05).Conclusions Low-dose esketamine can improve postoperative cognitive function in elderly patients undergoing non-cardiac surgery.