摘要
目的探讨围术期应用艾司氯胺酮对食管癌根治术后老年患者血清神经损伤标志物水平及术后谵妄(POD)发生率的影响。方法选择2021年2月至2021年12月于河南省胸科医院行食管癌根治术的老年患者80例,采用随机数字表法将其分为艾司氯胺酮组(E组)和阿片类药物组(O组),每组40例。麻醉诱导开始时,E组静注艾司氯胺酮0.5 mg/kg,麻醉维持期间艾司氯胺酮的给药速率为0.5 mg/(kg·h),术毕前30 min停用,术毕即刻连接经静脉患者自控镇痛(PCIA)泵,镇痛泵内加入艾司氯胺酮1.0 mg/kg+舒芬太尼50μg+布托啡诺12 mg+托烷司琼10 mg,辅以医用0.9%氯化钠注射液稀释至100 ml。O组静脉注射舒芬太尼0.2~0.4μg/kg,麻醉维持期间瑞芬太尼的给药速率为0.1~0.3μg/(kg·min),术毕前5 min停用,PCIA泵内加入舒芬太尼100μg+布托啡诺12 mg+托烷司琼10 mg,辅以医用0.9%氯化钠注射液稀释至100 ml。比较两组麻醉诱导前10 min、术毕,以及术后第1天、第2天和第3天时血清神经损伤标志物S100β蛋白和神经元特性烯醇化酶(NSE)水平。比较两组术前1 d及术后第1天、第3天时肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)和白细胞介素-8(IL-8)水平。比较两组术后3 d内的POD发生率。结果E组术后3 d内的POD发生率低于O组,差异有统计学意义(12.50%vs 32.50%;χ^(2)=4.588,P=0.032)。与O组比较,E组患者术中丙泊酚用量更少,麻醉后恢复室(PACU)停留时间更短,差异有统计学意义(P<0.05)。在观察时间内,两组S100β蛋白和NSE水平呈上升趋势,TNF-α、IL-6、IL-8水平呈先上升后下降的趋势,E组变化幅度均较O组小,差异有统计学意义(P<0.05)。结论围术期应用艾司氯胺酮可降低食管癌根治术后老年患者的S100β蛋白和NSE水平及POD发生率,其机制可能与艾司氯胺酮的抑炎作用有关。
Objective To investigate the effects of perioperative use of esketamine on the levels of serum neurological injury markers and the incidence of postoperative delirium(POD)in elderly patients after esophageal cancer radical surgery.Methods Eighty elderly patients who underwent esophageal cancer radical surgery in Henan Provincial Chest Hospital from February 2021 to December 2021 were selected and divided into esketamine group(group E)and opioid group(group O)by random number table method,with 40 cases in each group.At the beginning of anesthesia induction,the group E was given intravenous injection of esketamine 0.5 mg/kg.During the maintenance of anesthesia,the infusing rate of esketamine was 0.5 mg/(kg·h),and the patients were stopped infusing 30 minutes before the operation,and immediately after the operation,patient controlled intravenous analgesia(PCIA)pump was set,and esketamine 1.0 mg/kg+sufentanil 50μg+butorphanol 12 mg+tropisetron 10 mg was added to the analgesic pump,and diluted to 100 ml with normal saline.In the group O,sufentanil was injected intravenously with 0.2-0.4μg/kg.During the maintenance of anesthesia,the remifentanil was administered at an infusing rate of 0.1-0.3μg/(kg·min)and the patients were stopped infusing 5 minutes before the operation,and sufentanil was added to the PCIA pump,and fentanyl 100μg+butorphanol 12 mg+tropisetron 10 mg was diluted to 100 ml with normal saline.The levels of serum nerve injury marker S100βprotein and neuron-specific enolase(NSE)were compared between the two groups 10 minutes before induction of anesthesia,at the end of surgery,and on the 1st,2nd,and 3rd day after surgery.The levels of tumor necrosis factor-α(TNF-α),interleukin-6(IL-6)and interleukin-8(IL-8)were compared between the two groups on the 1st day before surgery and on the 1st and 3rd day after surgery.The incidence of POD within 3 days after surgery was compared between the two groups.Results The incidence of POD within 3 days after surgery in the group E was lower than that in the group
作者
王妮
马红霞
周俊辉
WANG Ni;MA Hong-xia;ZHOU Jun-hui(Department of Anesthesiology,Henan Provincial Chest Hospital,Zhengzhou 450008,China)
出处
《中国临床新医学》
2022年第10期955-960,共6页
CHINESE JOURNAL OF NEW CLINICAL MEDICINE
基金
河南省医学科技攻关计划-联合共建项目(编号:LHGJ20200220)。
关键词
艾司氯胺酮
术后谵妄
食管癌根治术
神经损伤标志物
老年患者
Esketamine
Postoperative delirium(POD)
Esophageal cancer radical surgery
Neurological injury marker
Elderly patient
