【罂粟摘要】艾司氯胺酮对非心脏胸外科手术患者术后负面情绪和早期认知障碍的影响

探究麻醉期单剂量注射艾司氯胺酮是否能改善非心脏胸外科手术患者术后负面情绪和早期认知功能。

129例成年患者在全身麻醉下接受了择期非心脏胸外科手术。干预措施：手术中，使用0.2mg/kg（低氯胺酮组）和0.5mg/kg（高氯胺酮组）与安慰剂进行术后负面情绪和早期认知障碍的药物预防。在术前第一天（POD-1）、术后第1天（POD1）和第3天（POD3）使用HADS-A、HADS-D、疼痛视觉模拟评分（VAS）、混淆评估方法（CAM）、小型精神状态检查（MMSE）和血清生物标志物（S100β、BDNF、IL-6、乙酰胆碱和去甲肾上腺素）评估情绪和早期认知能力。

高艾司氯胺酮组在POD1和POD3时HADS-A和HADS-D评分明显低于对照组。低艾司氯胺酮组与对照组之间无显著性差异。艾司氯胺酮治疗组在术后2h和术后第一天的疼痛VAS评分均低于对照组。三组间CAM评分和MMSE评分均无显著性差异。而高艾司氯胺酮组术后S100β和IL-6水平较低，BDNF水平较高，而血清乙酰胆碱和去甲肾上腺素无显著性差异。

术中单次注射艾司氯胺酮0.5 mg/kg可在一定程度上缓解术后焦虑、抑郁和疼痛。虽然认知功能行为评价没有显示出明显的益处，但它也可以减少促炎和脑损伤相关因子的产生，同时促进脑源性神经营养因子的产生。

原始文献来源：Luo T,Deng Z,Ren Q, et al. Effects of esketamine on postoperative negative emotions and early cognitive disorders in patients undergoing non-cardiac thoracic surgery: A randomized controlled trial. J Clin Anesth. 2024;95:111447.

Effects of esketamine on postoperative negative emotions and early cognitive disorders in patients undergoing non-cardiac thoracic surgery: A randomized controlled trial

Abstract   

Study objective: To investigate whether a single dosage of esketamine injection in the anesthesia period could improve postoperative negative emotions and early cognitive function in patients undergoing non-cardiac thoracic surgery.

Design: A prospective single center double blinded randomized placebo-controlled trial.

Setting: Perioperative period; operating room, post anesthesia care unit and hospital ward.

Patients: 129 adult patients that underwent elective non-cardiac thoracic surgery under general anesthesia.

Interventions: During the operation, pharmacologic prevention of postoperative negative emotion and early cognitive disorder with 0.2 mg/kg (Low esketamine group) and 0.5 mg/kg esketamine (High esketamine group) vs. placebo.

Measurements: Emotion and early cognitive performance were assessed on the day before surgery (POD-1), postoperative day 1 (POD1) and day 3 (POD3) using HADS-A, HADS-D, Pain Visual Analogue Scale (VAS), Confusion Assessment Method (CAM), Mini-Mental State Examination (MMSE), and serum biomarkers (S100β, BDNF, IL-6, acetylcholine, and norepinephrine).

Main results: The high esketamine group showed significantly lower HADS-A and HADS-D scores than control group on POD1 and POD3. No significant differences were observed between the low esketamine group and the control group. The esketamine-treated groups showed lower pain VAS scores than the control group at 2 h and on the first day after operation. There were no significant differences among the three groups in CAM and MMSE scores. However, the high esketamine group had lower S100β and IL-6 levels, and higher BDNF levels postoperatively, while serum acetylcholine and norepinephrine were not significantly different.

Conclusions: A single intraoperative injection of 0.5 mg/kg esketamine can alleviate postoperative anxiety, depression, and pain to some extent. Although cognitive function behavioral evaluation did not show obvious benefits, it can also reduce the production of pro-inflammatory and brain injury-related factors while promoting the generation of brain-derived neurotrophic factor.