小剂量艾司氯胺酮对老年衰弱病人髋关节置换术后谵妄和炎症因子的影响

doi:10.3969/j.issn.1003-9198.2024.12.004

摘要/Abstract

摘要： 目的探讨小剂量艾司氯胺酮对老年衰弱病人全麻髋关节置换术后谵妄(POD)和炎症因子的影响。方法选择2021年8月至2022年8月在南京中医药大学附属医院接受全麻下择期行髋关节置换术的老年衰弱病人60例,年龄65～85岁,美国麻醉医师协会(ASA)分级为Ⅱ或Ⅲ级,术前Fried衰弱量表评分≥3分。采用随机数表法将病人分为艾司氯胺酮组和对照组,每组30例。艾司氯胺酮组在麻醉诱导时静脉给予艾司氯胺酮0.2 mg/kg,对照组给予等容量生理盐水。分别于手术前1 d,手术后1、3 d收集2组病人的外周静脉血,检测血液中WBC、中性粒细胞与淋巴细胞比值(NLR),应用ELISA法检测病人血清中IL-6和hs-CRP的水平;记录手术时间、失血量、补液量以及术中舒芬太尼、丙泊酚、瑞芬太尼和血管活性药物的使用情况;使用意识模糊评估(CAM)量表评估病人POD发生情况;统计麻醉期间平均动脉压(MAP)、心率(HR)以及手术后3 d内不良反应的发生情况。结果与对照组相比,艾司氯胺酮组手术后3 d内POD发生率降低,术中舒芬太尼使用量减少(P＜0.01)。术后1、3 d,2组IL-6、hs-CRP水平呈上升趋势,但艾司氯胺酮组低于对照组,差异有统计学意义(P＜0.05);2组WBC和NLR水平呈现先上升后下降的趋势;术后1、3 d,对照组WBC和NLR水平均高于艾司氯胺酮组,差异有统计学意义(P<0.05);与对照组相比,麻醉期间艾司氯胺酮组不同时点MAP和HR水平均降低,差异具有统计学意义(P＜0.05)。2组不良反应发生率差异无统计学意义。结论全麻诱导时使用低剂量艾司氯胺酮可降低老年衰弱病人髋关节置换POD发生率,其机制可能与艾司氯胺酮抑制炎症反应、减少应激有关。

关键词: 艾司氯胺酮, 髋关节置换术, 老年人, 谵妄, 衰弱, 炎症因子

Abstract: Objective To investigate the effect of low-dose esketamine on postoperative delirium (POD) and the levels of inflammatory factors after total hip replacement surgery in the elderly patients with frailty. Methods A total of 60 elderly patients with frailty aged 65 to 85 years undergoing total hip replacement surgery under general anesthesia from August 2021 to August 2022 were enrolled in this study, and were divided into esketamine group and control group, with 30 patients in each group. The esketamine group received 0.2 mg/kg esketamine during induction of anesthesia and the control group received the same volume of saline. Peripheral venous blood was collected 1 d before surgery, 1 d and 3 d after surgery; White blood cell count (WBC), neutrophil to lymphocyte ratio (NLR), the levels of interleukin-6 (IL-6) and high sensitivity C-reactive protein(hs-CRP)were detected. The operation time, blood loss, fluid rehydration, and intraoperative use of sufentanil, propofol, remifentanil and vasoactive drugs were recorded. The mean arterial pressure(MAP) and heart rate(HR)were recorded during anesthesia. The incidence of POD was evaluated with the Confusion Assessment Method(CAM) scale and the adverse reactions within 3 days after operation were recorded. Results Compared with the control group, the incidence rate of POD was significant decreased in the esketamine group. The intraoperative sufentanil consumption in the esketamine group was decreased than that in the control group(P<0.01). On the first and third day after operation, the levels of IL-6 and hs-CRP in the two groups were increased, especially in the control group (P<0.05). The levels of WBC and NLR in the two groups increased first and then decreased. On the first and third day after operation, the levels of WBC and NLR in the control group were significantly higher than those in the esketamine group (P<0.05). Compared with the control group, the levels of MAP and HR in the esketamine group were significantly decreased at different time points during anesthesia (P<0.05). There was no significant difference in the incidence rate of adverse reaction between the two groups. Conclusions The use of low-dose esketamine during induction of general anesthesia can reduce the incidence of POD in the elderly patients with frailty receiving hip replacement surgery, and the mechanism may be related to the inhibition of inflammation and stress reaction.

Key words: esketamine, hip replacement, aged, delirium, frailty, inflammatory factor

中图分类号:

R 687.4

崔耀梅, 李雪飞, 谢丽霞, 武红会, 武茜. 小剂量艾司氯胺酮对老年衰弱病人髋关节置换术后谵妄和炎症因子的影响[J]. 实用老年医学, 2024, 38(12): 1205-1209.

CUI Yaomei, LI Xuefei, XIE Lixia, WU Honghui, WU Qian. Effect of low-dose esketamine in hip replacement surgery on postoperative delirium and inflammatory factors in elderly patients with frailty[J]. Practical Geriatrics, 2024, 38(12): 1205-1209.

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