文章摘要
术中持续输注艾司氯胺酮对老年患者髋关节置换术后谵妄的影响
Effect of esketamine administered continuously during the operation on postoperative delirium in elderly patients undergoing hip arthroplasty
  
DOI：10.12089/jca.2025.02.002
中文关键词: 术后谵妄  艾司氯胺酮  围术期  老年  髋关节置换术
英文关键词: Postoperative delirium  Esketamine  Perioperative period  Aged  Hip arthroplasty
基金项目:湖南省医学会医学科研基金（HMA202101016）
作者单位E-mail
印建军 415700,湖南省常德市,桃源县人民医院麻醉科  
肖亚芬 415700,湖南省常德市,桃源县人民医院麻醉科  
田敏 415700,湖南省常德市,桃源县人民医院麻醉科  
胡蓉 415700,湖南省常德市,桃源县人民医院麻醉科  
胡兴国 415700,湖南省常德市,桃源县人民医院麻醉科 mzhuxingguo@126.com 
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中文摘要:
      
目的：观察术中持续输注艾司氯胺酮在预防老年患者髋关节置换术后谵妄（POD）中的效果。
方法：选择在静脉全身麻醉下择期行髋关节置换术患者100例，男44例，女56例，年龄≥65岁，BMI≤35 kg/m2，ASA Ⅱ或Ⅲ级。采用随机数字表法将患者随机分为两组：艾司氯胺酮组（S组，n=51）和对照组（C组，n=49）。S组在麻醉诱导前静脉推注艾司氯胺酮0.3 mg/kg，随后持续泵注艾司氯胺酮0.125 mg·kg-1·h-1至术毕。C组在麻醉诱导前静脉推注生理盐水0.3 ml/kg，随后持续泵注生理盐水0.125 ml·kg-1·h-1至术毕。术后1、2、3 d采用意识混乱评估法（CAM）评估POD的发生情况。术后6、24、48、72 h采用Ramsay镇静评分法评估镇静程度。记录术后6、24、48、48 h VAS疼痛评分。记录术后48 h内镇痛泵总按压次数、有效按压次数、镇痛泵用量以及补救镇痛情况。于麻醉诱导前、术后24、72 h抽取外周静脉血，采用化学发光法测定血清S100β蛋白、神经元特异性烯醇化酶（NSE）、肿瘤坏死因子-α（TNF-α）、白细胞介素（IL）-1β浓度。
结果：与C组比较，S组术后3 d内POD发生率、术后镇静不足比例、术后24、48、72 h VAS疼痛评分明显降低，术后48 h内镇痛泵总按压次数、镇痛泵有效按压次数、镇痛泵用量明显减少，补救镇痛率明显降低（P<0.05）。与麻醉诱导前比较，C组术后24 h血清S100β蛋白、NSE、TNF-α和IL-1β浓度明显升高，术后72 h血清NSE浓度明显升高（P<0.05）。与C组比较，S组术后24、72 h S组血清S100β蛋白、NSE、TNF-α和IL-1β浓度明显降低（P<0.05）。
结论：术中持续输注艾司氯胺酮可降低老年髋关节置换术患者POD的发生率，其机制可能与艾司氯胺酮的抗炎作用有关。
英文摘要:
      
Objective: To investigate the effect of esketamine administered continuously during the operation on preventing postoperative delirium (POD) in elderly patients undergoing hip arthroplasty.
Methods: A total of 100 hospitalized patients scheduled for hip arthroplasty, 44 males and 56 females, aged ≥ 65 years, BMI ≤ 35 kg/m2, ASA physical status Ⅱ or Ⅲ, were randomly allocated into two groups according to the random number table: esketamine group (group S, n = 51) and control group (group C, n = 49). Before the induction of anesthesia, esketamine 0.3 mg/kg in group S and normal saline 0.3 ml/kg in group C were injected intravenously. After the induction, a continuous infusion of esketamine 0.125 mg·kg-1·h-1 in group S and normal saline 0.125 ml·kg-1·h-1 in group C will be cunducted until the end of the operation. The POD was assessed by confusion assessment method (CAM) 1 day, 2 and 3 days after the operation. Visual analog scale (VAS) pain scores and Ramsay sedation scale were evaluated 6, 24, 48, and 72 hours after the operation. The total number of analgesic pump compressions, the number of effective compressions, the amount of analgesic pump, and the relief of analgesia were recorded within 48 hours after surgery. Peripheral venous blood was drawn before anesthesia induction and 24,72 hours after the operation, to exammine the serum S100β protein, neuron-specific enolase (NSE), tumor necrosis factor-α (TNF-α) and interleukin-1β (IL-1β) levels.
Results: Compared with group C, the incidence of POD was significantly lower in group S, along with the proportion of insufficient sedation and VAS pain score 24, 48, and 72 hours after the operation (P < 0.05). The total number of PCIA compressions, effective number of PCIA compression, total dosage of PCIA within 48 hours after the operation, and the use of rescue analgesia were significantly lower (P < 0.05). The level of serum S100β, NSE, TNF-α, and IL-1β 24 hours after the operation and the level of NSE 72 hours after the operation were significantly higher compared with the serum before the operation in group C (P < 0.05). And the level of serum S100β, NSE, TNF-α and IL-1β 24 and 72 hours after the operation in group S were significantly lower than those in group C (P < 0.05).
Conclusion: The use of esketamine can reduce the POD rate in elderly patients undergoing hip arthroplasty, and the mechanism maybe related to its anti-inflammatory effect.
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