中国临床药学杂志

目的 探讨不同剂量艾司氯胺酮对老年直肠癌患者术后早期认知功能的影响。方法 选取2020年10月至2022年3月行直肠癌根治术的老年患者138例为研究对象,将患者随机分为艾司氯胺酮高剂量组(H组)、低剂量组(L组)和对照组(C组),每组46例。麻醉诱导时,H、L组分别予0.5 mg·kg^-1、0.25 mg·kg^-1艾司氯胺酮;C组予等量的生理盐水;3组术中均予以静脉吸入复合麻醉维持。比较3组不同时间点的视觉模拟疼痛(VAS)评分、血清学指标[神经元特异性烯醇化酶(NSE)、中枢神经特异性蛋白(S-100β)、肿瘤坏死因子-α(TNF-α)和白细胞介素-6(IL-6)]水平,简易智能状态检查量表(MMSE)评分和术后神经认知障碍(PND)发生率;比较3组围术期指标(术后苏醒时间、拔管时间)及术后不良反应发生情况。结果 术后1、3、7 d,H组和L组MMSE评分高于C组,PND发生率低于C组(P <0.05);术后6、12、24 h,H组和L组静息和咳嗽时VAS评分低于C组(P <0.05);H组和L组T₂、T₃、T₄时血清NSE、S-100β、TNF-α、IL-6水平低于C组(P <0.05);H组和L组术后苏醒时间和拔管时间短于C组(P <0.05);L组术后苏醒时间和拔管时间短于H组(P <0.05);H组总不良反应发生率高于L组和C组(P <0.05);L组和C组总不良反应发生率组间比较差异无统计学意义(P>0.05)。结论 老年直肠癌根治术患者予以艾司氯胺酮进行麻醉诱导能有效降低术后疼痛程度,减轻炎症反应和神经损伤,改善术后认知功能,减少PND发生,安全性较好,其中以0.25 mg·kg^-1剂量的安全性更好。

AIM To explore the effects of different doses of esketamine on early postoperative cognitive function in elderly patients with rectal cancer. METHODS A total of 138 elderly patients who underwent radical ractal cancer surgery from October 2020 to March 2022 were selected as the research subjects. The patients were randomly divided into esketamine high dose group(group H), low dose group(group L) and control group(group C), with 46 patients in each group. During anesthesia induction, 0.5 mg·kg^-1 and 0.25 mg·kg^-1 of esketamine were injected intravenously in group H and L, respectively, and the same amount of normal saline was injected intravenously in group C. The patients in 3 groups were maintained by intravenous inhalation combined anesthesia. The visual analog pain(VAS), the levels of serological indicators[neuron specific enolase(NSE), central nerve specific protein(S-100β), tumor necrosis factor-α(TNF-α)and interleukin-6(IL-6)], the scores of mini mental state examination(MMSE) and the incidence of postoperative neurocognitive disorder(PND) were compared among the 3 groups at different time points. The perioperative indexes(the postoperative extubation time, recovery time) and adverse reactions after operation were compared among the 3 groups.RESULTS At 1, 3 and 7 d after operation the MMSE score of group H and group L was higher than that of group C, the incidence of PND was lower than that of group C(P < 0.05). At 6, 12 and 24 h after operation, the VAS score of resting and coughing in group H and group L was lower than that in group C(P < 0.05). At T₂, T₃ and T₄, the serum NSE, S-100β,TNF-α and IL-6 in group H and group L were lower than those in group C(P < 0.05). The recovery time and extubation time of group H and group L were shorter than those of C group(P < 0.05). The recovery time and extubation time of group L were shorter than those of group H(P < 0.05), the difference between groups was statistically significant(P <0.05). The total adverse reaction rate in group H was higher than that in group L and C(P < 0.05). There was no difference in the incidence of total adverse reactions between group L and group C(P > 0.05). CONCLUSION Anesthesia induction with esketamine for elderly patients undergoing radical resection of rectal cancer can effectively reduce the degree of postoperative pain, reduce inflammatory reaction and nerve damage, improve postoperative cognitive function, reduce PND, with good safety, among which 0.25 mg·kg^-1 is better.