摘要译文（供参考）
小剂量艾司氯胺酮对老年恶性肿瘤择期非心脏手术患者围手术期神经认知障碍及术后抑郁症状的影响：一项随机临床试验
背景：
围手术期神经认知障碍和术后抑郁症状是术后的重要并发症。研究表明艾司氯胺酮具有神经保护和抗抑郁的性质。
方法：
本试验包括209名年龄在60至86岁接受肿瘤切除术的患者，他们在手术期间和手术后接受或不接受艾司氯胺酮(E组)。在E组中，患者在诱导全身麻醉10分钟后静脉注射艾司氯胺酮0.5mg/kg。此外，术后48小时内使用艾司氯胺酮(2mg/kg)联合舒芬太尼进行PCIA。C组用生理盐水替代艾司氯胺酮，采用神经心理测验和电话访谈评估认知功能，采用汉密尔顿抑郁量表17评定抑郁症状。
结果：
与C组相比，E组患者在术后3、7和90天表现出较低的抑郁症状发生率(53.9%vs67.7%，26.3%vs47.9%，13.3%vs28.4%)。在第7天和第90天，E组也显示了试着做试验的时间缩短。然而，两组术后1至5天谵妄或术后90天认知功能障碍的发生率无显著差异(12.1%vs10.9%和8.4%vs9.7%)。
结论：
术中小剂量艾司氯胺酮和术后小剂量艾司氯胺酮联合舒芬太尼静脉自控镇痛均能改善术后镇痛效果，减轻术后抑郁症状，有助于社会执行能力的恢复。然而，这种方法并不能减少术后谵妄或术后认知功能障碍的发生率。
原文摘要
Effect of small dose esketamine on perioperative neurocognitive disorder and postoperative depressive symptoms in elderly patients undergoing major elective noncardiac surgery for malignant tumors: A randomized clinical trial
Background: Perioperative neurocognitive disorder and postoperative depressive symptoms are significant complications after surgery. Studies have indicated that esketamine possesses neuroprotective and antidepressant qualities.
Methods: This trial included 209 patients aged 60 to 86 years undergoing tumor resection who received esketamine (Group E) or not (Group C) during and after surgery. In group E, patients were given an intravenous dose of 0.5 mg/kg of esketamine 10 minutes after induction of general anaesthesia. In addition, esketamine (2 mg/kg) in combination with sufentanil was used for PCIA during 48 hours postoperatively. On the other hand, saline was used as a substitute for esketamine in group C. Cognitive function was evaluated using neuropsychological tests and telephone interview for cognitive status-modified, and symptoms of depression were assessed using Hamilton Depression Rating Scale 17.
Results: Compared to Group C, patients in Group E exhibited lower rates of depressive symptoms at 3, 7, and 90 days post-surgery (53.9% vs 67.7%, 26.3% vs 47.9%, and 13.3% vs 28.4%). Group E also showed decreased time for Trail Making Test on days 7 and 90. However, there were no significant differences in the incidence of delirium 1 to 5 days post-surgery or cognitive impairment 90 days post-surgery between the 2 groups (12.1% vs 10.9% and 8.4% vs 9.7%).
Conclusions: Intraoperative low-dose esketamine and postoperative low-dose esketamine combined with sufentanil for patient-controlled intravenous analgesia has been shown to improve postoperative analgesia, alleviate postoperative depressive symptoms, and aid in the recovery of social executive ability. However, this approach did not reduce the incidence of postoperative delirium or postoperative cognitive dysfunction.
