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

doi:10.3969/j.issn.1003-9198.2024.10.016

Abstract

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

CLC Number:

R 749.16

SUN Li, YIN Weihong, JING Jun, QIAN Xiali. Effects of intraoperative subanesthetic dose of esketamine on early postoperative cognitive dysfunction in elderly patients undergoing spinal surgery[J]. Practical Geriatrics, 2024, 38(10): 1039-1043.

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

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