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亚麻醉剂量艾司氯胺酮对老年人胃肠道手术围手术期神经认知障碍的影响：一项随机对照试验

背景：

围手术期神经认知功能障碍（PND），包括神经认知恢复延迟（dNCR）和术后认知功能障碍（POCD），是老年患者常见的术后并发症，并对其预后产生不利影响。

目的：

本研究旨在探讨在全身麻醉下接受胃肠道手术的老年患者服用艾司氯胺酮对术后认知功能的影响及其潜在机制。

方法：

84名65岁及以上的胃肠道手术患者被随机分为两组：艾司氯胺酮组（S组）和对照组（C组）。

S组在手术开始前5分钟静脉注射亚麻醉剂量的艾司氯胺酮（0.15mg/kg），而C组则注射相同体积的生理盐水。

一组神经心理学测试用于评估术前、术后7天和3个月的认知功能。

主要结果是两组术后7天dNCR和术后3个月POCD的发生率。

次要转归指标包括手术前和手术后1天血清白细胞介素-6（IL-6）和钙结合蛋白β（S100β）水平的变化。

结果：

S组dNCR的发生率低于C组（18.15% vs 38.24%，P=0.033）。

相反，两组在术后3个月的POCD方面没有差异（6.06% vs 14.37%，P=0.247）。

术后第1天，两组血浆IL-6和S100β水平均显著升高（P；0.05），但与C组相比，艾司氯胺酮预处理在一定程度上降低了这些因子的水平（p＜0.05）。

结论：

亚麻醉剂量的艾司氯胺酮可能降低接受胃肠道手术的老年患者的dNCR发生率并改善术后早期认知功能，这可能与艾司氯胺酮的抗神经炎症作用有关。

关键词：

老年人；艾司氯胺酮；胃肠外科；神经炎症；围手术期神经认知功能障碍。

Effect of Subanesthetic Dose of Esketamine on Perioperative Neurocognitive Disorders in Elderly Undergoing Gastrointestinal Surgery: A Randomized Controlled Trial

Background: Perioperative neurocognitive disorders (PND), including delayed neurocognitive recovery (dNCR) and postoperative cognitive dysfunction (POCD), are common postoperative complications in elderly patients and adversely affect their prognosis. The study was designed to explore the effects of esketamine on postoperative cognitive function in elderly patients who underwent gastrointestinal surgery under general anesthesia and its potential mechanism.

Methods: Eighty-four patients aged 65 and above undergoing gastrointestinal surgery were randomly divided into 2 groups: the esketamine group (group S) and the control group (group C). Group S received intravenous sub-anesthetic doses of esketamine (0.15 mg/kg) 5 minutes before the initiation of surgery, while group C received the same volume of saline. A battery of neuropsychological tests was used to assess cognitive function before surgery, 7 days, and 3 months after surgery. The primary outcome was the incidence of dNCR at 7 days postoperatively and POCD at 3 months postoperatively in both groups. The secondary outcome measures included changes in the levels of serum interleukin-6 (IL-6) and calcium-binding protein β (S100β) before and 1 day after surgery.

Results: The incidence of dNCR in group S was lower than that of group C (18.15% vs 38.24% P=0.033). Contrarily, there was no difference in both groups regarding POCD 3 months postoperatively (6.06% vs 14.37% P=0.247). Plasma IL-6 and S100β levels were significantly elevated in both groups on postoperative day 1 (p