艾司氯胺酮对老年人群乳腺癌改良根治术后早期恢复和认知功能的影响

Effects of esketamine on early recovery and cognitive function after modified radical mastectomy in the elderly

目的观察术中使用艾司氯胺酮对老年人群乳腺癌术后早期恢复和认知功能的影响。方法选择择期全身麻醉下行乳腺癌根治手术的老年女性患者100例,采用随机数字法分为艾司氯胺酮组(E组)50例,手术开始前给予0.25 mg/kg艾司氯胺酮单次推注并以0.125 kg/h的速度维持;对照组(C组)50例,给予同样容积的生理盐水。记录术中及术毕24 h、48 h内的阿片类药物需求量,术中心血管不良反应发生率。随访术后3 d、7 d的汉密尔顿抑郁量表(hamilton depression rating sale,HAMD-17)评分和术后恢复质量评分(quality of recovery-15 scale,QoR-15),术后3 d内的术后蒙特利尔认知评估和简易智力状态(mini-mental state examination,MMSE)评分,计算神经认知恢复延迟(delayed neurocognitive recovery,DNR)发生率。结果与C组相比,E组可降低术中(41.8±7.7 vs.38.4±7.1,t=1.34,P=0.027)和术后24 h(35.9±4.5 vs.33.4±4.1,t=2.09,P=0.005)的舒芬太尼用量,同时降低术中低血压[19(40.4%)vs.9(18.7%),χ^(2)=3.42,P=0.025]和心动过速的发生[6(12.7%)vs.0(0%),χ^(2)=4.17,P=0.012]。虽术后3 d内谵妄的发生率两组差异无统计学意义,但E组仍可降低HAMD-17及DNR的发生率[13(27.6%)vs.2(4.1%),χ^(2)=6.02,P=0.001],同时提高术后3 d的QoR-15评分(78.7±9.2 vs.82.7±6.2,t=7.52,P=0.01)。结论术中使用艾司氯胺酮可减少阿片类药物用量及术后认知恢复延迟的发生率,同时提高术后早期的患者满意度。

Objective To observe the effect of intraoperative use of esketamine on early recovery and cognitive function after breast cancer surgery in the elderly population.Methods 100 elderly female patients who underwent elective radical surgery for breast cancer under general anesthesia were selected and randomly divided into the esketamine group(group E,50 cases).A single bolus injection of 0.25 mg/kg esketamine was given before the start of the operation and 0.125/kg esketamine was administered.The speed of kg/h was maintained.The control group(group C,50 cases)were given the same volume of normal saline.The demand for opioids during the operation and within 24 hours and 48 hours after the operation,as well as the incidence of adverse cardiovascular reactions during the operation,were recorded.The Hamilton depression rating scale(HAMD-17)score and satisfaction score(QoR-15)were followed up for 3 days and 7 days after surgery,and the postoperative Montreal cognitive assessment,mini-mental state(MMSE)score within 3 days after surgery,and incidence of delayed neurocognitive recovery(DNR)were calculated.Results Compared with group C,group E could reduce the dosage of sufentanil during surgery and 24 hours after surgery(intraoperative:41.8±7.7 vs.38.4±7.1μg,t=1.34,P=0.027;24 hours after surgery:[(35.9±4.5)vs.(33.4±4.1)μg,t=2.09,P=0.005],while reducing the occurrence of intraoperative hypotension(19(40.4%)vs.9(18.7%),χ^(2)=3.42,P=0.025)and tachycardia(6(12.7%)vs 0(0%),χ^(2)=4.17,P=0.012).Although there was no statistical difference in the incidence of delirium between the two groups within 3 days after surgery,group E could still reduce the incidence of HAMD-17 and DNR(13(27.6%)vs.2(4.1%),χ^(2)=6.02,P=0.001),while improving the QoR-15 score 3 days after surgery(78.7±9.2 vs.82.7±6.2,t=7.52,P=0.01).Conclusion Intraoperative use of esketamine can reduce opioid consumption and the incidence of delayed postoperative cognitive recovery,while improving early postoperative patient satisfaction.