瑞马唑仑联合艾司氯胺酮对老年肺叶切除术POD及对NLRP3/caspase-1的影响  

Effects of remimazolam combined with esketamine on POD and NLRP3/caspase-1 in elderly patients undergoing lobectomy

作　　者：贾志杰 段文姣 张晓冉[1] JIA Zhijie;DUAN Wenjiao;ZHANG Xiaoran(Department of Anesthesiology,the First Affiliated Hospital of Xinxiang Medical College,Xinxiang,Henan,China,453000;Department of Anesthesiology,Qi County People's Hospital,Hebi,Henan,China,456750)

机构地区：[1]新乡医学院第一附属医院麻醉科,河南新乡453000 [2]淇县人民医院麻醉科,河南鹤壁456750

出　　处：《分子诊断与治疗杂志》2025年第3期474-477,482,共5页Journal of Molecular Diagnostics and Therapy

基　　金：河南医学科技攻关计划项目(LHGJ20220594)。

摘　　要：目的探究瑞马唑仑联合低剂量艾司氯胺酮对老年胸腔镜肺叶切除术患者术后谵妄(POD)及对NOD样受体热蛋白结构域相关蛋白3(NLRP3)/含半胱氨酸的天冬氨酸蛋白水解酶(caspase)-1通路的影响。方法选取2022年8月至2024年3月期间在新乡医学院第一附属医院行胸腔镜肺叶切除术的老年患者428例,随机分为低剂量艾司氯胺酮联合丙泊酚组(KP组)和低剂量艾司氯胺酮联合瑞马唑仑组(KR组),每组各214例。KP组脱落5例,完成209例,KR组脱落7例,完成207例。KP组麻醉诱导给予艾司氯胺酮0.5 mg/kg和丙泊酚2.0 mg/kg,KR组给予艾司氯胺酮0.5 mg/kg和瑞马唑仑0.1 mg/kg。比较两组术后5 d内POD的发生情况。比较两组术后1 d和3 d白细胞介素(IL)-18和IL-1β的表达水平以及NLRP3和caspase-1的基因相对表达量。结果术后5 d内KR组POD发生率显著低于KP组,差异有统计学意义(P<0.05)。KR组术后1 d和3 d的IL-18和IL-1β表达水平均显著低于KP组,差异有统计学意义(P<0.05)。两组术后1 d及3 d的NLRP3和caspase-1的基因相对表达相比,KR组的显著低于KP组,差异有统计学意义(P<0.05)。结论瑞马唑仑联合低剂量艾司氯胺酮能有效通过影响NLRP3/caspase-1通路减轻老年胸腔镜肺叶切除术患者术后的炎症反应,改善POD的发生情况。Objective To investigate the effects of remimazolam combined with low-dose esketamine on postoperative delirium(POD)and on the NOD like receptor thermal protein domain associated protein 3(NLRP3)/cysteinyl aspartate specific proteinase(caspase)-1 pathway in elderly patients undergoing thoracoscopic lobectomy.Methods A total of 428 elderly patients who underwent thoracoscopic lobectomy at the First Affiliated Hospital of Xinxiang Medical College between August 2022 and March 2024 were selected and randomly divided into the low-dose esketamine combined with propofol group(KP group)and the lowdose esketamine combined with remimazolam group(KR group),with 214 patients in each group.There were 5 dislodged cases and 209 completed cases in the KP group,while there were 7 dislodged cases and 207 completed cases in the KR group.For anesthesia induction in the KP group,esketamine was administered at 0.5 mg/kg and propofol at 2.0 mg/kg,and esketamine 0.5 mg/kg and remimazolam 0.1 mg/kg were given in the KR group.The occurrence of POD within 5 days after surgery was compared between the two groups.Additionally,the expression levels of interleukin(IL)-18 and IL-1β,as well as the relative gene expressions of NLRP3 and caspase-1,were compared between the two groups at 1 and 3 days postoperatively.Results The incidence of POD in the KR group was significantly lower than that in the KP group within 5 days postoperatively,and the difference was statistically significant(P<0.05).The expression levels of IL-18 and IL-1β in the KR group were significantly lower than those in the KP group at 1 day and 3 days postoperatively,and the difference was statistically significant(P<0.05).When comparing the relative gene expression of NLRP3 and caspase-1 at 1 day and 3 days postoperatively in the two groups,those in the KR group were significantly lower than those in the KP group,and the difference was statistically significant(P<0.05).Conclusion Remimazolam,when combined with a low-dose of esketamine,proved to be effective in reducing the p

关 键 词：瑞马唑仑 艾司氯胺酮 肺叶切除术 老年患者 术后谵妄 

分 类 号：R73[医药卫生—肿瘤]