引用本文:王 妮,马红霞,周俊辉.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发生率的影响[J].中国临床新医学,2022,15(10):955-960.
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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发生率的影响
王 妮,马红霞,周俊辉
450008 郑州,河南省胸科医院麻醉科
摘要:
[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50 μg+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0.2~0.4 μg/kg,麻醉维持期间瑞芬太尼的给药速率为0.1~0.3 μg/(kg·min),术毕前5 min停用,PCIA泵内加入舒芬太尼100 μg+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%; χ2=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。
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
DOI:10.3969/j.issn.1674-3806.2022.10.12
分类号:R 614
基金项目:河南省医学科技攻关计划-联合共建项目(编号:LHGJ20200220)
Effects of perioperative use of esketamine on the levels of serum neurological injury markers and the incidence of postoperative delirium in elderly patients after esophageal cancer radical surgery
WANG Ni, MA Hong-xia, ZHOU Jun-hui
Department of Anesthesiology, Henan Provincial Chest Hospital, Zhengzhou 450008, China
Abstract:
[Abstract] 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 50 μg+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 0.2-0.4 μg/kg. During the maintenance of anesthesia, the remifentanil was administered at an infusing rate of 0.1-0.3 μg/(kg·min) and the patients were stopped infusing 5 minutes before the operation, and sufentanil was added to the PCIA pump, and fentanyl 100 μg+butorphanol 12 mg+tropisetron 10 mg was diluted to 100 ml with normal saline. The levels of serum nerve injury marker S100β protein 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 O, and the difference was statistically significant(12.50% vs 32.50%; χ2=4.588, P=0.032). Compared with those in the group O, the patients in the group E had less intraoperative propofol dosage and shorter post-anesthesia recovery unit(PACU) stay time, and the differences were statistically significant(P<0.05). During the observation period, the levels of S100β protein and NSE in the two groups showed an upward trend, and the levels of TNF-α, IL-6, and IL-8 showed a trend of first increasing and then decreasing, and the changes in the group E were smaller than those in the group O, and the differences were statistically significant(P<0.05). Conclusion Perioperative use of esketamine can reduce the levels of S100β protein and NSE and the incidence of POD in elderly patients after esophageal cancer radical surgery, and the mechanisms may be related to the anti-inflammatory effect of esketamine.
Key words:  Esketamine  Postoperative delirium(POD)  Esophageal cancer radical surgery  Neurological injury marker  Elderly patient