小剂量艾司氯胺酮对老龄髋关节置换术患者术后谵妄的影响  

Effect of low-dose esketamine on postoperative delirium in elderly patients undergoing hip arthroplasty

作　　者：任红 周广伟 付莉莉 张咏晖[2] 胡斌[2] 张岚[2] 张满和[2] 王英[2] REN Hong;ZHOU Guangwei;FU Lili;ZHANG Yonghui;HU Bin;ZHANG Lan;ZHANG Manhe;WANG Ying(Department of Anesthesiology,the First Medical Center,Chinese PLA General Hospital,Beijing 100853,China;Anesthesiology Department of Tangshan Gongren Hospital,Tangshan 063000,Hebei Province,China)

机构地区：[1]解放军总医院第一医学中心麻醉科,北京100853 [2]唐山市工人医院麻醉科,河北唐山063000

出　　处：《解放军医学院学报》2023年第8期857-861,共5页Academic Journal of Chinese PLA Medical School

基　　金：河北省卫生健康委医学科研课题(20211730,20221798)。

摘　　要：背景 术后谵妄是老龄大手术患者常见的术后神经系统并发症,目前无有效的预防和治疗措施。目的 探究小剂量艾司氯胺酮对接受髋关节置换术老年患者术后谵妄发生情况的影响。方法 选取2020年9月-2021年10月因关节退行性变择期在唐山市工人医院全身麻醉气管内插管下行单侧全髋关节置换术的老年患者60例(年龄65~75岁),随机分为两组:艾司氯胺酮组(A组)患者麻醉诱导静脉注射艾司氯胺酮0.2 mg/kg、咪达唑仑0.03~0.06 mg/kg、阿芬太尼20~40μg/kg、依托咪酸0.1~0.3 mg/kg及罗库溴铵0.6 mg/kg;对照组(B组)患者麻醉诱导静脉注射与艾司氯胺酮等容量0.9%氯化钠注射液、咪达唑仑0.03~0.06 mg/kg、阿芬太尼20~40μg/kg、依托咪酯0.1~0.3 mg/kg及罗库溴铵0.6 mg/kg。两组术中均采用静脉麻醉维持。记录两组患者麻醉诱导前(T0)、诱导后5 min (T1)、诱导后10 min (T2)、手术开始(T3)、手术结束(T4)的平均动脉压(mean arterial pressure,MAP)及心率(heart rate,HR)。采用酶联免疫吸附法测定麻醉诱导前(T0)、手术结束(T4)、术后1d (T5)、术后3 d (T6)静脉血中S100钙结合蛋白β(S100 calcium binding protein beta,S100β蛋白)及炎性因子肿瘤坏死因子-α(tumor necrosis factor-alpha,TNF-α)和白细胞介素-6(interleukin6,IL-6)、IL-10水平。采用3D-CAM量表评估术后5 d内谵妄的发生情况。结果 两组患者年龄、性别、ASA分级、体质量指数及手术时间差异均无统计学意义(P>0.05)。两组患者MAP在T1、T2时刻较T0时刻均显著升高(多重校正P<0.013),且在T1和T2时刻A组的MAP显著低于B组,差异有统计学意义(P<0.05)。两组HR在T1-3时刻较T0时刻均显著升高(多重校正P<0.013),在T1和T2时刻A组HR显著低于B组,差异有统计学意义(P<0.05)。两组患者血液中TNF-α、IL-6水平在T4-6时刻较T0显著增加(多重校正P<0.017),且T4-6时刻A组显著低于B组,差异有统计学意义(P<0.05)。两组IL-10水平在T4-6时�Background Postoperative delirium is a common postoperative neurological complication which has no effective preventive and therapeutic measures in elderly patients with major surgery.Objective To investigate the effect of low-dose esketamine on the occurrence of postoperative delirium in elderly patients undergoing hip arthroplasty.Methods Elderly patients with elective degenerative joint disease who underwent hip arthroplasty under general anesthesia from September 2020 to October 2021 in Tangshan Gongren Hospital,aged 65-75 years old,were randomly divided into esketamine group(group A)and control group(group B).Patients in group A were induced with intravenous injection of esketamine 0.2 mg/kg,midazolam 0.03-0.06 mg/kg,alfentanil 20-40μg/kg,etomidate 0.1-0.3 mg/kg and rocuronium 0.6 mg/kg,while patients in group B were induced with intravenous injection of saline in the same volume as esketamine,midazolam 0.03-0.06 mg/kg,alfentanil 20-40μg/kg,etomidate 0.1-0.3 mg/kg and rocuronium 0.6 mg/kg.Patients in both groups were maintained by intravenous anesthesia.The mean arterial pressure(MAP)and heart rate(HR)were recorded before anesthesia induction(T0),5 minutes after induction(T1),10 minutes after induction(T2),at the beginning of surgery(T3),and at the end of surgery(T4).The levels of S100 calcium binding protein beta(S100β),the inflammatory factors tumor necrosis factor-alpha(TNF-α)and interleukin-6(IL-6)in venous blood were measured by enzyme-linked immunosorbent assay at the following time points:induction of anesthesia(T0),the end of surgery(T4),1 day after surgery(T5),and 3 days after surgery(T6).The 3D-CAM scale was used to assess the occurrence of delirium within 5 days after surgery.Results There was no significance in age,sex ratio,ASA,BMI and operation time between the two groups(P>0.05).MAP increased significantly in both groups at T1 and T2 compared with T0(multiple correction,P<0.013),MAP decreased significantly in group A at T1 and T2 compared with group B(P<0.05);HR increased significantly in

关 键 词：术后谵妄 老年人 艾司氯胺酮 麻醉 髋关节置换术 

分 类 号：R614[医药卫生—麻醉学]