辅助用依他佐辛对行髋关节骨折手术的老年患者抑郁的影响：一项随机对照试验。
Effects of adjunctive esketamine on depression in elderly patients undergoing hip fracture surgery: a randomized controlled trial.
机构信息
Department of Anesthesiology, Wenzhou People's Hospital, 57 CanHou street, Wenzhou, 325000, China.
出版信息
BMC Anesthesiol. 2024 Sep 28;24(1):340. doi: 10.1186/s12871-024-02733-0.
BACKGROUND
Depression is a prevalent perioperative psychiatric complication among elderly hip fracture patients. Esketamine has rapid and robust antidepressant effects. However, it is unknown whether it can alleviate depressive symptoms in elderly patients who undergo hip fracture surgery. This study aimed to explore whether the adjunctive esketamine in patient-controlled intravenous analgesia (PCIA) could improve depressive symptoms in elderly patients undergoing hip fracture surgery.
METHODS
A single-center, prospective, double-blind and randomized controlled clinical trial was carried out from July 2022 to August 2023 at the Wenzhou People's Hospital among 90 patients, aged ≥ 65 years with hip fracture undergoing elective surgery. Participants were randomly allocated to either the esketamine group (group S) or the control group (group C). In Group S, patients were administered 0.5 mg/kg of esketamine as a PCIA adjuvant for 48 h, while the control group received saline. The primary outcome was the assessment of depressive symptoms using the Geriatric Depression Scale-15 (GDS-15) on postoperative day 2. The secondary outcomes were assessments of depressive symptoms on postoperative day 7 and postoperative day 30, serum levels of brain-derived neurotrophic factor (BDNF) and 5-hydroxytryptamine (5-HT), postoperative pain intensity, the number of effective PCIA presses, sufentanil consumption, and adverse events.
RESULTS
The prevalence and GDS-15 scores of depression were significantly lower in group S on postoperative day 2 (28.6% vs. 53.5%; 3.5 ± 1.8 vs. 4.3 ± 1.7, P < 0.05). In group S, the number of effective PCIA presses was significantly lower on postoperative day 2 than that in group C [2(1-4) vs. 1(0-2), P<0.05]. Higher levels of BDNF (23.8 ± 1.7 ng/mL vs. 25.3 ± 2.0 ng/mL, P < 0.05) and 5-HT (219.5 ± 19.5 ng/mL vs. 217.0 ± 22.2 ng/mL, P < 0.05) in the blood were observed on postoperative day 2 in group S.
CONCLUSION
In elderly patients aged ≥ 65 years undergoing hip fracture surgery, the administration of adjunctive esketamine in PCIA could improve depressive symptoms and increase levels of BDNF and 5-HT in the blood.
TRIAL REGISTRATION
Chinese Clinical Trial Registry, ChiCTR2200061956 (Date: 13/07/2022).
背景
抑郁是老年髋部骨折患者围手术期常见的精神并发症。氯胺酮具有快速而强大的抗抑郁作用。然而，目前尚不清楚它是否可以缓解接受髋部骨折手术的老年患者的抑郁症状。本研究旨在探讨辅助氯胺酮在患者自控静脉镇痛（PCIA）中是否可以改善髋部骨折手术老年患者的抑郁症状。
方法
本研究为 2022 年 7 月至 2023 年 8 月在温州市人民医院进行的一项单中心、前瞻性、双盲、随机对照临床试验，共纳入 90 名年龄≥65 岁、择期行髋部骨折手术的老年患者。参与者被随机分配到氯胺酮组（S 组）或对照组（C 组）。在 S 组中，患者接受 0.5mg/kg 的氯胺酮作为 PCIA 辅助剂，持续 48 小时，而对照组则给予生理盐水。主要结局是术后第 2 天使用老年抑郁量表-15 项（GDS-15）评估抑郁症状。次要结局是术后第 7 天和第 30 天评估抑郁症状、脑源性神经营养因子（BDNF）和 5-羟色胺（5-HT）血清水平、术后疼痛强度、有效 PCIA 按压次数、舒芬太尼消耗和不良事件。
结果
S 组术后第 2 天抑郁的发生率和 GDS-15 评分明显低于 C 组（28.6% vs. 53.5%；3.5±1.8 vs. 4.3±1.7，P<0.05）。S 组术后第 2 天 PCIA 按压有效次数明显少于 C 组[2（1-4） vs. 1（0-2），P<0.05]。S 组术后第 2 天血液 BDNF（23.8±1.7ng/mL vs. 25.3±2.0ng/mL，P<0.05）和 5-HT（219.5±19.5ng/mL vs. 217.0±22.2ng/mL，P<0.05）水平明显高于 C 组。
结论
在年龄≥65 岁接受髋部骨折手术的老年患者中，PCIA 中辅助氯胺酮可改善抑郁症状，并增加血液中的 BDNF 和 5-HT 水平。
试验注册
中国临床试验注册中心，ChiCTR2200061956（日期：2022 年 7 月 13 日）。
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