亚麻醉剂量S-氯胺酮预处理对腹腔镜胃肠肿瘤根治术老年患者术后认知功能的影响

Effect of subanesthetic dose of S-ketamine pretreatment on postoperative cognitive function in elderly patients undergoing laparoscopic radical resection of gastrointestinal tumor

目的探讨亚麻醉剂量S-氯胺酮预处理对腹腔镜胃肠肿瘤根治术老年患者术后认知功能的影响。方法全身麻醉下行腹腔镜胃肠肿瘤根治术的老年患者100例,采用随机数字表法均分为S-氯胺酮组(S组)和对照组(C组)。麻醉诱导前10 min,S组静脉注射S-氯胺酮0.2 mg/kg,C组则给予等容量生理盐水。分别于给药前(T0)、切皮后1 h(T1)、术后3 h(T2)和术后24 h(T3)检测血清神经特异性烯醇化酶(NSE)和S-100β水平。采用蒙特利尔认知评估(MoCA)量表评估两组患者术后认知功能。术后7 d,比较两组患者术后认知功能障碍(POCD)的发生率。结果T1~T3时两组血清NSE、S-100β水平较T0时升高(P<0.05)。与C组比较,T1~T3时S组血清NSE、S-100β水平降低(P<0.05)。术后1、3、7 d,两组患者MoCA评分均低于术前(P<0.05),而S组MoCA评分高于C组(P<0.05)。术后7 d,S组POCD发生率低于C组(4%vs.16%)(P<0.05)。结论亚麻醉剂量S-氯胺酮预处理用于腹腔镜胃肠肿瘤根治术老年患者能减少POCD的发生。

Objective To explore the effect of subanesthetic dose of S-ketamine pretreatment on postoperative cognitive function in elderly patients undergoing laparoscopic radical resection of gastrointestinal tumor.Methods A total of 100 patients undergoing laparoscopic radical resection of gastrointestinal tumor under general anesthesia were divided into two groups with 50 cases each.Ten minutes before anesthesia induction,group S was given intravenous injection of S-ketamine 0.2 mg/kg and group C was given equal volume of normal saline.Serum levels of neuron specific enolase(NSE)and S-100βwere measured before administration(T0),one hour after skin incision(T1),3 hours after surgery(T2)and 24 hours after surgery(T3).The Montreal Cognitive Assessment(MoCA)scale was used to assess cognitive function,the incidence of postoperative cognitive dysfunction(POCD)was evaluated 7 days after surgery.Results Serum levels of NSE and S-100βof two groups were higher at T1-T3 than those at T0(P<0.05).Compared with group C,serum levels of NSE and S-100βin group S were decreased at T1-T3(P<0.05).The MoCA scores of two groups were lower in the is,3rd and 7th day after surgery than those before(P<0.05),which were higher in group S than those in group C(P<0.05).The incidence of POCD was lower in group S than that in group C 7 days after surgery(4%vs.16%)(P<0.05).Conclusion Subanesthetic dose of S-ketamine pretreatment may reduce the occurrence of POCD in elderly patients undergoing laparoscopic radical resection of gastrointestinal tumor.