Xi Lei, Liu Hui, Tang XiaoJuan, Jiang ZhenZhen
Department of Anesthesiology, Renmin Hospital, Hubei University of Medicine, Shiyan, Hubei, People's Republic of China.
Department of Radiology, Renmin Hospital, Hubei University of Medicine, Shiyan, Hubei, People's Republic of China.
Clin Transl Sci. 2025 Aug;18(8):e70232. doi: 10.1111/cts.70232.
This study aimed to evaluate the effects of esketamine combined with remimazolam tosylate on hemodynamic stability, cerebral oxygen metabolism, and cognitive outcomes in patients undergoing heart valve replacement. Seventy-eight patients were randomized to Group C (dexmedetomidine hydrochloride) or Group R (esketamine + remimazolam tosylate). The following parameters were measured: multiple time points, including mean arterial pressure (MAP), heart rate (HR), respiratory rate (RR), arterial-jugular vein oxygen content difference (Da-jvO), cerebral oxygen uptake rate (CERO), and biomarkers of myocardial injury (cTnI, CK-MB, FABP) at baseline (T0), incision (T1), sternotomy (T2), pre-cardiopulmonary bypass (T3), and post-surgery (T4). Cognitive function was assessed using the Mini-Mental State Examination (MMSE) and Confusion Assessment Method (CAM). Group R showed prolonged values of lower RR in T1 to T4 than Group C (p < 0.05). The Da-jvO and CERO were found to be much higher in Group R in T2, T3, and T4 (p < 0.05). This is an indication of improved cerebral oxygen metabolism. MMSE scores were elevated in Group R: the incidence of delirium and CAM Scores were lower compared with Group C (p < 0.05). This indicates better cognitive outcomes. Also, cTnI, CK-MB, and FABP, myocardial injury markers, were significantly reduced in Group R at postoperative 24 and 72 h (p < 0.05), indicating reduced myocardial injury. The combination of esketamine and remimazolam tosylate offers hemodynamic stability, enhances cerebral oxygen metabolism, improves cognitive function, and reduces myocardial injury in patients undergoing heart valve replacement surgery. This approach might provide significant benefits in cardiovascular anesthesia.
本研究旨在评估艾司氯胺酮联合甲苯磺酸瑞马唑仑对心脏瓣膜置换术患者血流动力学稳定性、脑氧代谢和认知结局的影响。78例患者被随机分为C组（盐酸右美托咪定）或R组（艾司氯胺酮+甲苯磺酸瑞马唑仑）。测量以下参数：多个时间点，包括基线（T0）、切口时（T1）、胸骨切开时（T2）、体外循环前（T3）和术后（T4）的平均动脉压（MAP）、心率（HR）、呼吸频率（RR）、动脉-颈静脉血氧含量差（Da-jvO）、脑氧摄取率（CERO）以及心肌损伤生物标志物（肌钙蛋白I、肌酸激酶同工酶、脂肪酸结合蛋白）。使用简易精神状态检查表（MMSE）和谵妄评估方法（CAM）评估认知功能。R组在T1至T4期间RR较低值的持续时间比C组更长（p < 0.05）。在T2、T3和T（4）时，R组的Da-jvO和CERO明显更高（p < 0.05）。这表明脑氧代谢得到改善。R组的MMSE评分升高：谵妄发生率和CAM评分低于C组（p < 0.05）。这表明认知结局更好。此外，R组术后24小时和72小时的心肌损伤标志物肌钙蛋白I、肌酸激酶同工酶和脂肪酸结合蛋白显著降低（p < 0.05），表明心肌损伤减轻。艾司氯胺酮和甲苯磺酸瑞马唑仑联合使用可提供血流动力学稳定性，增强脑氧代谢，改善认知功能，并减少心脏瓣膜置换手术患者的心肌损伤。这种方法可能在心血管麻醉中带来显著益处。
