实用老年医学

实用老年医学 ›› 2024, Vol. 38 ›› Issue (10): 1039-1043.doi: 10.3969/j.issn.1003-9198.2024.10.016

• 临床研究 • 上一篇    下一篇

亚麻醉剂量艾司氯胺酮对老年脊柱手术病人术后早期认知功能障碍的影响

孙丽, 尹卫红, 经俊, 钱夏丽   

  1. 243000 安徽省马鞍山市,马鞍山市人民医院麻醉科(孙丽,尹卫红,经俊);
    210004 江苏省南京市,南京医科大学附属妇产医院(南京市妇幼保健院)麻醉科(钱夏丽)
  • 收稿日期:2023-11-13 出版日期:2024-10-20 发布日期:2024-10-22
  • 通讯作者: 钱夏丽,Email:1435790860@qq.com
  • 基金资助:
    中国红十字会基金会医学赋能公益专项基金"医学赋能及人才培养计划"临床科研项目

Effects of intraoperative subanesthetic dose of esketamine on early postoperative cognitive dysfunction in elderly patients undergoing spinal surgery

SUN Li, YIN Weihong, JING Jun, QIAN Xiali   

  1. Department of Anesthesiology, Maanshan People’s Hospital, Maanshan 243000, China (SUN Li, YIN Weihong, JING Jun);
    Department of Anesthesiology, Women’s Hospital of Nanjing Medical University (Nanjing Women and Children’s Healthcare Hospital), Nanjing 210004, China(QIAN Xiali)
  • Received:2023-11-13 Online:2024-10-20 Published:2024-10-22
  • Contact: QIAN Xiali, Email:1435790860@qq.com

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摘要： 目的 观察亚麻醉剂量艾司氯胺酮对老年脊柱病人术后认知功能障碍(POCD)和髓样细胞触发受体1(TREM1)、TREM2表达的影响。 方法 选择2022年10月至2023年9月,在马鞍山市人民医院行全麻下脊柱手术的老年病人60例,按照随机数表法分为观察组(n=30)和对照组(n=30),观察组在麻醉诱导时静脉注射0.2 mg/kg艾司氯胺酮,对照组予等量的生理盐水,2组病人的其他麻醉用药相同。比较2组病人麻醉前后的MoCA评分、TREM1、TREM2、平均动脉压(MAP)、心率(HR)、局部脑氧饱和度(rSO2)水平及术后早期POCD发生情况。 结果 观察组手术后第1、3、7天的MoCA评分均高于对照组(P<0.05)。2组手术前后TREM2水平差异均无统计学意义(P>0.05);术后观察组TREM1水平无明显变化,对照组TREM1水平明显升高(P<0.05),且术后24、72 h的TREM1水平均高于观察组,差异有统计学意义(P<0.05)。在麻醉诱导后各时间点,观察组rSO2水平明显高于对照组(P<0.05),2组间MAP和HR差异无统计学意义(P>0.05)。观察组术后早期POCD发生率明显低于对照组(6.7%比30.0%,P<0.05)。 结论 亚麻醉剂量艾司氯胺酮能够维持老年脊柱手术病人麻醉后较高的rSO2水平,且对术中循环无明显影响;同时能够抑制术后外周血中TREM1的上调,减轻炎症反应,降低早期POCD的发生率。

关键词: 艾司氯胺酮, 老年人, 脊柱手术, 认知功能障碍, 局部脑氧饱和度, 髓样细胞触发受体

Abstract: Objective To investigate the effects of intraoperative subanesthetic dose of esketamine on early postoperative cognitive dysfunction (POCD) and the expression of triggering receptor expressed on myeloid cells 1 (TREM1) and TREM2 in the elderly patients undergoing spinal surgery. Methods From October 2022 to September 2023, 60 elderly patients who underwent spinal surgery under general anesthesia were selected and divided into observation group (n=30) and control group (n=30) according to random number table method. The patients in observation group were intravenously injected with esketamine 0.2 mg/kg, while the patients in control group were treated with the same amount of saline before anesthesia induction. Two groups received the same anesthetic drugs. The levels of mean arterial pressure (MAP), heart rate (HR), regional oxygen saturation (rSO2), Montreal cognitive assessment (MoCA) score, TREM1 and TREM2 were observed and compared between the two groups before and after anesthesia. The incidences of POCD and adverse reactions were also recorded. Results The MoCA scores in observation group 1, 3, 7 d after the surgery were significantly higher than those in control group (P<0.05). The level of TREM2 showed no significant change in the two groups after the operation (P>0.05). The level of TREM1 showed no significant change in observation group after the operation. Compared with observation group, the level of TREM1 in control group was significantly increased 24 h and 72 h after the operation (P<0.05). At each time point after anesthesia induction, the level of rSO2 in observation group was significantly higher than that in control group (P<0.05), and there were no significant differences in the levels of MAP and HR between the two groups. The incidence rate of early POCD in observation group was significantly lower than that in control group (6.7% vs 30.0%,P<0.05). Conclusions The sub-anesthetic dose of esketamine can maintain a higher rSO2 in the elderly patients undergoing spinal surgery after anesthesia without obvious effect on the intraoperative circulation; At the same time, it can inhibit the upregulation of the level of TREM1 in peripheral blood, reduce the inflammatory reactions and the incidence of the early POCD in the elderly patients after spinal surgery.

Key words: esketamine, aged, spinal surgery, postoperative cognitive dysfunction, regional oxygen saturation, triggering receptor expressed on myeloid cells

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