Lee Ki Hwa, Kim Ji Yeon, Kim Jeong Won, Park Jang Su, Lee Kyu Won, Jeon Sang Yoon
Department of Anesthesia and Pain Medicine, Haeundae Paik Hospital, Inje University, Busan, South Korea.
Department of Anesthesia and Pain Medicine, Ilsan Paik Hospital, Inje University, Goyang, South Korea.
Anesth Pain Med. 2015 Oct 17;5(5):e28844. doi: 10.5812/aapm.28844. eCollection 2015 Oct.
Postoperative cognitive dysfunction (POCD) is a serious and frequent complication after surgery, especially in elderly patients. Ketamine is an N-methyl D-aspartic acid receptor antagonist with demonstrated neuroprotective effects. An intravenous bolus of a sub-anesthetic dose (0.5 mg/kg) of ketamine can reduce postoperative delirium (POD) and POCD after cardiac surgery. But, the influence of ketamine on early POCD after non-cardiac surgery is unclear.
The current study aimed to evaluate the influence of ketamine on early postoperative cognitive function after orthopedic surgery in elderly patients.
Fifty six elderly patients (> 60-years-old), scheduled for elective orthopedic surgery during general anesthesia (duration of anesthesia > two hours) were enrolled. Patients received intravenous bolus, a total of 3 mL mixed with 0.9% normal saline and 0.5 mg/kg ketamine (K group) or 3 mL of 0.9% normal saline (N group). Three neurocognitive function tests (mini-mental status examination, trail-making test, digit substitution test), and c-reactive protein (CRP) concentration were determined before surgery and on postoperative day one (POD 1) and postoperative day six (POD 6).
The two groups had similar demographic characteristics except for the gender. Surgical and anesthetic data were not significantly different. A statistically significant difference was observed in comparison of trail-making test score. Trail-making test score increased more in the N group (52.5 points) than the K group (13 points) at POD 1 (P = 0.047) compared with baseline scores. There were no significant differences in the mini-mental status examination, digit substitution test and CRP concentration at POD 1 and POD 6 between the two groups. POCD (the two Z-scores in more than two tests or the combined Z-score was 1.96 or more) was present in one patient (4%) in the K group at POD 6 (P = 0.98).
The incidence of POCD was not significantly influenced by a bolus dose of ketamine (0.5 mg/kg) after orthopedic surgery in elderly patients. There were no negative effects of ketamine on early POCD.
术后认知功能障碍（POCD）是手术后一种严重且常见的并发症，尤其在老年患者中。氯胺酮是一种N-甲基-D-天冬氨酸受体拮抗剂，已证实具有神经保护作用。静脉注射亚麻醉剂量（0.5mg/kg）的氯胺酮可降低心脏手术后的术后谵妄（POD）和POCD。但是，氯胺酮对非心脏手术后早期POCD的影响尚不清楚。
本研究旨在评估氯胺酮对老年患者骨科手术后早期认知功能的影响。
纳入56例计划在全身麻醉（麻醉持续时间>2小时）下进行择期骨科手术的老年患者（>60岁）。患者接受静脉推注，共3mL与0.9%生理盐水混合的0.5mg/kg氯胺酮（K组）或3mL 0.9%生理盐水（N组）。在手术前、术后第1天（POD 1）和术后第6天（POD 6）进行三项神经认知功能测试（简易精神状态检查、连线试验、数字替代试验）以及C反应蛋白（CRP）浓度测定。
除性别外，两组的人口统计学特征相似。手术和麻醉数据无显著差异。在连线试验得分比较中观察到统计学显著差异。与基线得分相比，在POD 1时，N组（52.5分）的连线试验得分比K组（13分）增加更多（P = 0.047）。两组在POD 1和POD 6时的简易精神状态检查、数字替代试验和CRP浓度无显著差异。在POD 6时，K组有1例患者（4%）出现POCD（两项以上测试中的两个Z分数或合并Z分数为1.96或更高）（P = 0.98）。
老年患者骨科手术后，氯胺酮推注剂量（0.5mg/kg）对POCD的发生率无显著影响。氯胺酮对早期POCD无负面影响。
