Hudetz J A, Iqbal Z, Gandhi S D, Patterson K M, Byrne A J, Hudetz A G, Pagel P S, Warltier D C
Department of Anesthesiology, Clement J. Zablocki Veterans Administration Medical Center, Milwaukee, WI.
Acta Anaesthesiol Scand. 2009 Aug;53(7):864-72. doi: 10.1111/j.1399-6576.2009.01978.x. Epub 2009 Apr 28.
Post-operative cognitive dysfunction (POCD) commonly occurs after cardiac surgery. Ketamine exerts neuroprotective effects after cerebral ischemia by anti-excitotoxic and anti-inflammatory mechanisms. We hypothesized that ketamine attenuates POCD in patients undergoing cardiac surgery concomitant with an anti-inflammatory effect.
Patients randomly received placebo (0.9% saline; n=26) or an i.v. bolus of ketamine (0.5 mg/kg; n=26) during anesthetic induction. Anesthesia was maintained with isoflurane and fentanyl. A nonsurgical group (n=26) was also included as control. Recent verbal and nonverbal memory and executive functions were assessed before and 1 week after surgery or a 1-week waiting period for the nonsurgical controls. Serum C-reactive protein (CRP) concentrations were determined before surgery and on the first post-operative day.
Baseline neurocognitive and depression scores were similar in the placebo, ketamine, and nonsurgical control groups. Cognitive performance after surgery decreased by at least 2 SDs (z-score of 1.96) in 21 patients in the placebo group and only in seven patients in the ketamine group compared with the nonsurgical controls (P<0.001, Fisher's exact test). Cognitive performance was also significantly different between the placebo- and the ketamine-treated groups based on all z-scores (P<0.001, Mann-Whitney U-test). Pre-operative CRP concentrations were similar (P<0.33, Mann-Whitney U-test) in the placebo- and ketamine-treated groups. The post-operative CRP concentration was significantly (P<0.01, Mann-Whitney U-test) lower in the ketamine-treated than in the placebo-treated group.
Ketamine attenuates POCD 1 week after cardiac surgery and this effect may be related to the anti-inflammatory action of the drug.
心脏手术后常发生术后认知功能障碍（POCD）。氯胺酮通过抗兴奋毒性和抗炎机制对脑缺血发挥神经保护作用。我们假设氯胺酮可减轻心脏手术患者的POCD，并伴有抗炎作用。
患者在麻醉诱导期间随机接受安慰剂（0.9%生理盐水；n = 26）或静脉推注氯胺酮（0.5 mg/kg；n = 26）。麻醉维持采用异氟烷和芬太尼。还纳入了一个非手术组（n = 26）作为对照。在手术前以及手术后1周或非手术对照组的1周等待期前后，评估近期言语和非言语记忆及执行功能。在手术前和术后第一天测定血清C反应蛋白（CRP）浓度。
安慰剂组、氯胺酮组和非手术对照组的基线神经认知和抑郁评分相似。与非手术对照组相比，安慰剂组21例患者术后认知表现至少下降2个标准差（z分数为1.96），而氯胺酮组仅7例患者出现这种情况（P<0.001，Fisher精确检验）。基于所有z分数，安慰剂治疗组和氯胺酮治疗组之间的认知表现也存在显著差异（P<0.001，Mann-Whitney U检验）。安慰剂组和氯胺酮治疗组术前CRP浓度相似（P<0.33，Mann-Whitney U检验）。氯胺酮治疗组术后CRP浓度显著低于安慰剂治疗组（P<0.01，Mann-Whitney U检验）。
氯胺酮可减轻心脏手术后1周的POCD，这种作用可能与该药物的抗炎作用有关。
