摘要
Abstract
Objective To investigate the effect of the subanesthetic dose of ketamine preconditioning on the postoperative cognitive function in elderly patients. Methods Sixty ASA I or II elderly patients, scheduled for subtotal gastrectomy, 35 males and 25 females , with preoperative mini-mental state examination( MMSE ) scores above 23 , were randomized into 2 groups: control group( n = 30 ) and ketamine group( n = 30 ). After induction of general anesthesia, the patients received an intramuscular injection of 1. 0 mg/kg ketamine in ketamine group and the same volume of physiological saline in control group, and then intubated. After surgery, all patients had access to PCIA for 3 d to maintain the good postoperative analgesia. Mini-mental state examination( MMSE ) was used to evaluate the cognitive function Id before operation and at 24,48 ,72 h after operation,and recorded as the baseline. Peripheral venous blood samples were taken to detect the levels of IL-1 (3, IL-6, and TNF-ct one day before surgery, and 1,24,48,72 h after surgery. Results There was no significant difference between two groups with respect to age, weight, gender, the duration of the operation, the duration of the anaesthesia, MMSE baseline score and the total amount of anaesthetic ( P >0. 05 ). Compared with control group,the serum levels of IL-1 (3, IL-6 and TNF-ct were significantly increased after operation in ketamine group( P <0. 05 ). After operation,serum concentrations of IL-1 (3,IL-6 and TNF-a were increased significantly in control group( P<0.05 ),but not in ketamine group( P>0.05 ). The incidences of postoperative cognitive dysfunction( POCD ) were 33. 3% ,23.3% ,10.0% in control group at 24,48,72 h after surgery,respectively, and 20. 0% ,13.0% ,6. 6% in ketamine group. The incidence of POCD at 1,2 d after surgery in control group were significantly higher than those in ketamine group ( P < 0. 05 ), but no significant difference was found at 3 d after surgery between two groups. Conclusion The results suggest that subanesthetic dose of ketamine preconditioning has protective effect on postoperative cognitive dys-function( POCD ) in elderly patients, and that it can decrease the incidence of POCD, which may be related with the anti-inflammatory effect of ketamine.关键词
氯胺酮/认知障碍/术后并发症/老年人Key words
ketamine/ cognitive dysfunction/ postoperative complications/ elderly people分类
医药卫生
