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Abstract：
OBJECTIVE: To investigate the effects of low-dose S-ketamine on marker of myocardial injury (BNP, hs-cTnT and HFABP) after thoracoscopic lobectomy in patients aged 70 to 85.
METHODS: One hundred patients (four cases excluded) aged 70-85 years, with body mass index 18-24 kg·m-2 and American Society of Anesthesiologists physical status II-III, scheduled for elective lobectomy from April 2022 to April 2023, were selected. The patients were divided into two groups by a random number table method, namely, the low-dose S-ketamine combined with GDFT group (group S) and the control group (group C), with 48 cases in each group. In group S, a low dose of S-ketamine (0.2 mg/kg) was given 1 min before intubation, and the maintenance dose was 0.12 mg·kg-1·h-1. Fluid therapy, guided by cardiac index (CI), changes in stroke volume (△SV), and other dynamic indicators, was used for rehydration during the operation. Group C was given the same amount of normal saline (0.2 mg/kg) 1 min before intubation, and the same rehydration therapy was adopted during the operation. The mean arterial pressure (MAP) and heart rate (HR) of the two groups were observed and recorded immediately after entering the operating room (T0), immediately after intubation (T1), immediately after the beginning of one-lung ventilation (OLV) (T2), immediately after the beginning of surgery (T3), immediately after the end of OLV (T4), and at the end of surgery (T5). The intraoperative fluid intake and output and the use of vasoactive drugs were recorded. The plasma levels of heart-type fatty acid-binding protein (HFABP), high-sensitivity troponin T (hs-cTnT), brain natriuretic peptide (BNP), interleukin-6 (IL-6), interleukin-8 (IL-8), and tumor necrosis factor-α (TNF-α) were recorded 24 h before operation and 24 and 48 h after operation. Visual analogue scale (VAS) pain scores at rest were recorded at 2 (V1), 6 (V2), 12 (V3), 24 (V4), and 48 h (V5) after operation, and the occurrence of myocardial ischemia during hospitalization was noted.
RESULTS: Compared with group C, MAP was significantly higher at T1-T5 in group S (P < 0.05), and the plasma concentrations of IL-6, IL-8, TNF-α, BNP, hs-cTnT, and HFABP were significantly lower at 24 and 48 h after operation (P < 0.05). The VAS pain scores at 2, 6, 12, 24, and 48 h after operation, the number of effective patient-controlled intravenous analgesia (PCIA) compressions, and the total number of PCIA compressions within 48 h after operation were significantly decreased (P < 0.05). Compared with group C, The hospitalization days, and the incidence of postoperative myocardial ischemia in group S were lower (P < 0.05). There were no significant intergroup differences in urine volume, extubation time, the incidence of postoperative atrial fibrillation, bleeding volume, colloid infusion volume, total fluid infusion volume, and the incidence of rescue analgesia.
CONCLUSIONS: Low-dose S-ketamine can reduce the levels of hs-cTnT, HFABP, and BNP in older patients after pulmonary lobectomy, which has a positive effect on preventing myocardial injury.
BACKGROUND: This study was registered on CHICTR (registration No. ChiCTR2300074475). Date of registration: 08/08/2023.
METHODS: One hundred patients (four cases excluded) aged 70-85 years, with body mass index 18-24 kg·m-2 and American Society of Anesthesiologists physical status II-III, scheduled for elective lobectomy from April 2022 to April 2023, were selected. The patients were divided into two groups by a random number table method, namely, the low-dose S-ketamine combined with GDFT group (group S) and the control group (group C), with 48 cases in each group. In group S, a low dose of S-ketamine (0.2 mg/kg) was given 1 min before intubation, and the maintenance dose was 0.12 mg·kg-1·h-1. Fluid therapy, guided by cardiac index (CI), changes in stroke volume (△SV), and other dynamic indicators, was used for rehydration during the operation. Group C was given the same amount of normal saline (0.2 mg/kg) 1 min before intubation, and the same rehydration therapy was adopted during the operation. The mean arterial pressure (MAP) and heart rate (HR) of the two groups were observed and recorded immediately after entering the operating room (T0), immediately after intubation (T1), immediately after the beginning of one-lung ventilation (OLV) (T2), immediately after the beginning of surgery (T3), immediately after the end of OLV (T4), and at the end of surgery (T5). The intraoperative fluid intake and output and the use of vasoactive drugs were recorded. The plasma levels of heart-type fatty acid-binding protein (HFABP), high-sensitivity troponin T (hs-cTnT), brain natriuretic peptide (BNP), interleukin-6 (IL-6), interleukin-8 (IL-8), and tumor necrosis factor-α (TNF-α) were recorded 24 h before operation and 24 and 48 h after operation. Visual analogue scale (VAS) pain scores at rest were recorded at 2 (V1), 6 (V2), 12 (V3), 24 (V4), and 48 h (V5) after operation, and the occurrence of myocardial ischemia during hospitalization was noted.
RESULTS: Compared with group C, MAP was significantly higher at T1-T5 in group S (P < 0.05), and the plasma concentrations of IL-6, IL-8, TNF-α, BNP, hs-cTnT, and HFABP were significantly lower at 24 and 48 h after operation (P < 0.05). The VAS pain scores at 2, 6, 12, 24, and 48 h after operation, the number of effective patient-controlled intravenous analgesia (PCIA) compressions, and the total number of PCIA compressions within 48 h after operation were significantly decreased (P < 0.05). Compared with group C, The hospitalization days, and the incidence of postoperative myocardial ischemia in group S were lower (P < 0.05). There were no significant intergroup differences in urine volume, extubation time, the incidence of postoperative atrial fibrillation, bleeding volume, colloid infusion volume, total fluid infusion volume, and the incidence of rescue analgesia.
CONCLUSIONS: Low-dose S-ketamine can reduce the levels of hs-cTnT, HFABP, and BNP in older patients after pulmonary lobectomy, which has a positive effect on preventing myocardial injury.
BACKGROUND: This study was registered on CHICTR (registration No. ChiCTR2300074475). Date of registration: 08/08/2023.
摘要：
目的：探讨小剂量S-氯胺酮对心肌损伤标志物的影响（BNP，hs-cTnT和HFABP）在70至85岁的胸腔镜肺叶切除术后。
方法：100例患者（4例除外），年龄70-85岁，体重指数为18-24kg·m-2，美国麻醉医师协会的身体状况为II-III，计划于2022年4月至2023年4月进行选择性肺叶切除术。采用随机数字表法将患者分为两组,即,小剂量S-氯胺酮联合GDFT组(S组)和对照组(C组),每组48例。在S组中，插管前1分钟给予低剂量的S-氯胺酮（0.2mg/kg），维持剂量为0.12mg·kg-1·h-1。液体疗法,以心指数（CI）为指导，每搏输出量的变化(△SV)，和其他动态指标，用于手术期间的补液。C组于插管前1min给予等量生理盐水(0.2mg/kg),术中采用相同的补液治疗。观察并记录两组患者进入手术室后即刻(T0)的平均动脉压(MAP)和心率(HR),插管后立即（T1），在单肺通气（OLV）（T2）开始后立即，手术开始后（T3），OLV结束后立即（T4），在手术结束时（T5）。记录术中液体的摄入量和输出量以及血管活性药物的使用情况。心脏型脂肪酸结合蛋白（HFABP）的血浆水平，高敏肌钙蛋白T（hs-cTnT），脑钠肽（BNP），白细胞介素-6（IL-6），白细胞介素-8（IL-8），分别于术前24h及术后24、48h记录肿瘤坏死因子-α(TNF-α)。2(V1)记录静息时视觉模拟评分(VAS)疼痛评分,6(V2),12(V3),24(V4),术后48小时（V5），住院期间发生心肌缺血。
结果：与C组相比，在T1-T5时,S组MAP明显升高(P<0.05),和血浆IL-6，IL-8，TNF-α的浓度，BNP,hs-cTnT,术后24h和48hHFABP均明显降低(P<0.05)。术后2、6、12、24和48h的VAS疼痛评分，有效的患者自控静脉镇痛（PCIA）按压次数，术后48h内PCIA按压次数明显减少(P<0.05)。与C组相比,住院天数,S组术后心肌缺血发生率较低(P<0.05)。两组间尿量无显著差异,拔管时间,术后心房颤动的发生率，出血量,胶体输注量,总输液量,和抢救镇痛的发生率。
结论：低剂量S-氯胺酮可降低hs-cTnT水平，HFABP,肺叶切除术后老年患者的BNP，对预防心肌损伤有积极作用。
背景：本研究在CHICTR注册（注册编号：ChiCTR2300074475）。注册日期：2023年8月8日。
方法：100例患者（4例除外），年龄70-85岁，体重指数为18-24kg·m-2，美国麻醉医师协会的身体状况为II-III，计划于2022年4月至2023年4月进行选择性肺叶切除术。采用随机数字表法将患者分为两组,即,小剂量S-氯胺酮联合GDFT组(S组)和对照组(C组),每组48例。在S组中，插管前1分钟给予低剂量的S-氯胺酮（0.2mg/kg），维持剂量为0.12mg·kg-1·h-1。液体疗法,以心指数（CI）为指导，每搏输出量的变化(△SV)，和其他动态指标，用于手术期间的补液。C组于插管前1min给予等量生理盐水(0.2mg/kg),术中采用相同的补液治疗。观察并记录两组患者进入手术室后即刻(T0)的平均动脉压(MAP)和心率(HR),插管后立即（T1），在单肺通气（OLV）（T2）开始后立即，手术开始后（T3），OLV结束后立即（T4），在手术结束时（T5）。记录术中液体的摄入量和输出量以及血管活性药物的使用情况。心脏型脂肪酸结合蛋白（HFABP）的血浆水平，高敏肌钙蛋白T（hs-cTnT），脑钠肽（BNP），白细胞介素-6（IL-6），白细胞介素-8（IL-8），分别于术前24h及术后24、48h记录肿瘤坏死因子-α(TNF-α)。2(V1)记录静息时视觉模拟评分(VAS)疼痛评分,6(V2),12(V3),24(V4),术后48小时（V5），住院期间发生心肌缺血。
结果：与C组相比，在T1-T5时,S组MAP明显升高(P<0.05),和血浆IL-6，IL-8，TNF-α的浓度，BNP,hs-cTnT,术后24h和48hHFABP均明显降低(P<0.05)。术后2、6、12、24和48h的VAS疼痛评分，有效的患者自控静脉镇痛（PCIA）按压次数，术后48h内PCIA按压次数明显减少(P<0.05)。与C组相比,住院天数,S组术后心肌缺血发生率较低(P<0.05)。两组间尿量无显著差异,拔管时间,术后心房颤动的发生率，出血量,胶体输注量,总输液量,和抢救镇痛的发生率。
结论：低剂量S-氯胺酮可降低hs-cTnT水平，HFABP,肺叶切除术后老年患者的BNP，对预防心肌损伤有积极作用。
背景：本研究在CHICTR注册（注册编号：ChiCTR2300074475）。注册日期：2023年8月8日。
