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低剂量艾斯氯胺酮对老年髋关节或膝关节置换术后谵妄的影响：一项随机对照试验
贵州医科大学 麻醉与心脏电生理课题组
翻译：王婷婷 编辑：王波 审校：曹莹
老年患者在髋关节或膝关节置换术后的前三天内，重复低剂量艾斯氯胺酮注射并不能降低谵妄的发生率。
原始文献来源：Ma CB, Zhang CY, Gou CL, et al. Effect of Low-Dose Esketamine on Postoperative Delirium in Elderly Patients Undergoing Total Hip or Knee Arthroplasty: A Randomized Controlled Trial. Drug Des Devel Ther. 2024;18:5409-5421. Published 2024 Nov 26. doi:10.2147/DDDT.S477342.
Effect of Low-Dose Esketamine on Postoperative Delirium in Elderly Patients Undergoing Total Hip or Knee Arthroplasty: A Randomized Controlled Trial
Purpose: Postoperative delirium (POD) is a prevalent and severe complication in elderly patients undergoing major surgery, associated with increased morbidity and mortality. This randomized controlled trial aimed to investigate the effects of low-dose esketamine on the incidence of POD in elderly patients underwent total hip or knee arthroplasty.
Patients and Methods: Two hundred and sixty elderly participants were randomly assigned to either the esketamine group (Group E) (0.20mg/kg loading, 0.125mg/kg/h infusion, 0.5 mg/kg for postoperative analgesia) or the placebo group (Group P) (received normal saline). The primary outcome was the incidence of POD, with secondary outcomes including delirium subtypes, duration, intraoperative analgesic consumption, operative and anesthesia times, hemodynamic changes, postoperative pain scores, sleep quality, and common postoperative adverse events.
Results: There was no significant difference in the incidence of POD between Group E (8.5%) and Group P (10.8%). No significant differences were observed for the time of delirium onset, duration of delirium, and delirium subtype between the two groups. Patients in the esketamine group had more stable hemodynamic profile after induction and reduced the pain score of motion on the first two days postoperatively but increased the incidence of postoperative dizziness.
Conclusion: The repeated infusion of low-dose esketamine did not reduce the incidence of POD during the initial three postoperative days in elderly patients following total hip or knee arthroplasty.
Keywords: esketamine, delirium, aged, arthroplasty
