Department of Anesthesiology, Kunshan First People's Hospital, Kunshan Hospital Affiliated to Jiangsu University, No.566 Qianjin East Road, Kunshan, 215300, China.
J Cardiothorac Surg. 2024 Jun 7;19(1):324. doi: 10.1186/s13019-024-02811-x.
Postoperative delirium (POD) and cognitive dysfunction (POCD) are common complications following thoracic surgery, particularly in patients aged 65 years and above. These complications can significantly affect recovery and increase healthcare costs. This study investigates the effects of low-dose S-ketamine on reducing POD and POCD in this patient demographic.
In this retrospective cohort study, medical records of patients aged ≥ 65 years who underwent elective thoracic surgery from January 2019 to August 2023 were reviewed. Patients were categorized into S-ketamine and Control groups based on intraoperative S-ketamine exposure. POD was assessed using the Confusion Assessment Method (CAM), while cognitive function was evaluated using the Montreal Cognitive Assessment (MoCA) at baseline, 1 week, 1 month, and 6 months post-surgery. Intraoperative and postoperative parameters, including hemodynamic stability, blood loss, pain scores, and ICU stay length, were also recorded.
The study comprised 140 participants, with 70 in each group. The S-ketamine group demonstrated a significantly lower incidence of POD at 7 days post-surgery (12.0% vs. 26.7%, P < 0.001), and reduced POCD at 1 month (18.7% vs. 36.0%, P < 0.05) and 6 months (10.7% vs. 21.3%, P < 0.05). The Ketamine group had a significantly higher median MoCA score compared to the Control group both at 1 month (P = 0.021) and 6 months (P = 0.007). Adverse events, such as infection, bleeding, and respiratory failure, showed no significant differences between the groups, suggesting a safe profile for S-ketamine.
Administering low-dose S-ketamine during thoracic surgery in patients aged 65 years and above significantly reduces the incidence of POD and POCD, highlighting its neuroprotective potential. These findings advocate for the inclusion of S-ketamine in anesthetic protocols to improve postoperative outcomes and reduce healthcare costs in this patient population.
术后谵妄（POD）和认知功能障碍（POCD）是胸部手术后的常见并发症，尤其在 65 岁及以上的患者中更为常见。这些并发症会显著影响患者的康复并增加医疗保健成本。本研究旨在探讨小剂量 S-氯胺酮对降低该年龄段患者 POD 和 POCD 的效果。
这是一项回顾性队列研究，纳入了 2019 年 1 月至 2023 年 8 月期间接受择期胸部手术的年龄≥65 岁的患者的病历记录。根据术中 S-氯胺酮暴露情况，患者分为 S-氯胺酮组和对照组。使用意识模糊评估法（CAM）评估 POD，使用蒙特利尔认知评估量表（MoCA）评估认知功能，分别在基线、术后 1 周、1 个月和 6 个月进行评估。同时记录术中及术后的参数，包括血流动力学稳定性、失血量、疼痛评分和 ICU 住院时间。
本研究共纳入 140 名患者，每组 70 名。S-氯胺酮组在术后 7 天的 POD 发生率明显较低（12.0% vs. 26.7%，P<0.001），在术后 1 个月（18.7% vs. 36.0%，P<0.05）和 6 个月（10.7% vs. 21.3%，P<0.05）时 POCD 发生率也较低。与对照组相比，S-氯胺酮组在术后 1 个月（P=0.021）和 6 个月（P=0.007）时的 MoCA 中位数评分均显著更高。两组的感染、出血和呼吸衰竭等不良事件发生率无显著差异，表明 S-氯胺酮具有安全的特性。
在 65 岁及以上的患者接受胸部手术时，给予小剂量 S-氯胺酮可显著降低 POD 和 POCD 的发生率，提示其具有神经保护作用。这些发现支持将 S-氯胺酮纳入麻醉方案，以改善该患者群体的术后转归并降低医疗保健成本。
