亚麻醉剂量氯胺酮对老年骨科全麻患者术后谵妄及血清GABA、S100β蛋白的影响  

Effect of sub-anesthetic dose of ketamine on postoperative delirium,serum GABA and S100βprotein in elderly patients undergoing orthopedic general anesthesia surgery

作　　者：张辉然 鲁稳梁[2] 董真真[2] Zhang Huiran;Lu Wenliang;Dong Zhenzhen(The First People's Hospital of Ruzhou,Henan Ruzhou 467500 China;The Second Affiliated Hospital of Zhengzhou University,Henan Zhengzhou 450000 China.)

机构地区：[1]汝州市第一人民医院,河南汝州467500 [2]郑州大学第二附属医院,河南郑州450000

出　　处：《实验与检验医学》2022年第6期659-662,共4页Experimental and Laboratory Medicine

基　　金：河南省医学科技攻关重点项目,编号201702019。

摘　　要：目的探讨亚麻醉剂量氯胺酮对老年骨科全麻患者术后谵妄及血清γ-氨基丁酸(GABA)、中枢神经特异性蛋白(S100β蛋白)的影响。方法选取2018年10月至2019年12月拟实施骨科全麻手术的146例老年患者,分为实验组71例和对照组75例。对照组仅实施全麻,实验组实施亚麻醉剂量的氯胺酮(在麻醉诱导前静脉注射氯胺酮0.5 mg/kg)复合全麻。比较两组血清GABA与S100β蛋白水平、术后谵妄发生率、Ramsay镇静评分,分析血清GABA与S100β蛋白水平与Ramsay镇静评分的相关性。结果实验组术后2、6、12、24 h时的血清GABA、S100β水平均低于对照组(P<0.05)。实验组术后谵妄发生率为8.45%低于对照组的21.33%(P<0.05)。实验组术后2、6、12、24 h时的Ramsay镇静评分均高于对照组(P<0.05)。两组各时间点血清GABA、S100β蛋白水平与Ramsay镇静评分均呈负相关(P<0.05)。结论在骨科全麻手术中应用亚麻醉剂量氯胺酮可以降低术后谵妄发生率,亚麻醉剂量氯胺酮的抗谵妄作用可能与降低GABA、S100β蛋白水平有关。Objective To investigate the effect of sub-anaesthetic dose of ketamine on postoperative delirium,serum gamma aminobutyric acid(GABA)and central nervous system specific protein(S100βprotein)in elderly patients undergoing orthopedic general anesthesia surgery.Methods A total of 146 elderly patients scheduled to undergo orthopedic general anesthesia surgery from October 2018 to December 2019 were selected and divided into experimental group(71 cases)and control group(75 cases).The control group received general anesthesia alone,while the experimental group received sub-anaesthetic doses of ketamine(intravenous injection of 0.5 mg/kg of ketamine before anesthesia induction)combined with general anesthesia.The serum GABA and S100βprotein,the incidence of postoperative delirium and Ramsay sedation score were compared between the two groups.The correlation between serum GABA and S100βprotein levels and Ramsay Sedation score was analyzed.Results The serum GABA and S100βprotein levels in the experimental group were lower than those in the control group at 2 h,6 h,12 h and 24 h after operation(P<0.05).The incidence of postoperative delirium in the experimental group was 8.45%,lower than 21.33%in the control group(P<0.05).The Ramsay sedation scores in the experimental group were higher than those in the control group at 2 h,6 h,12 h,and 24 h after surgery(P<0.05).Serum GABA and S100βprotein levels at each time point in the two groups were negatively correlated with the Ramsay sedation scores(P<0.05).Conclusion Applying sub-anaesthetic dose of ketamine in orthopedic general anesthesia surgery can reduce the incidence of postoperative delirium.The anti-delirium effect of sub-anaesthetic dose of ketamine may be related to the reduction of GABA and S100βprotein levels.

关 键 词：全麻 氯胺酮 亚麻醉剂量 γ-氨基丁酸 S100Β蛋白 

分 类 号：R614.2[医药卫生—麻醉学]