Abstract：
OBJECTIVE: To investigate whether a single dosage of esketamine injection in the anesthesia period could improve postoperative negative emotions and early cognitive function in patients undergoing non-cardiac thoracic surgery.
METHODS: A prospective single center double blinded randomized placebo-controlled trial.
METHODS: Perioperative period; operating room, post anesthesia care unit and hospital ward.
METHODS: 129 adult patients that underwent elective non-cardiac thoracic surgery under general anesthesia.
METHODS: During the operation, pharmacologic prevention of postoperative negative emotion and early cognitive disorder with 0.2 mg/kg (Low esketamine group) and 0.5 mg/kg esketamine (High esketamine group) vs. placebo.
METHODS: Emotion and early cognitive performance were assessed on the day before surgery (POD-1), postoperative day 1 (POD1) and day 3 (POD3) using HADS-A, HADS-D, Pain Visual Analogue Scale (VAS), Confusion Assessment Method (CAM), Mini-Mental State Examination (MMSE), and serum biomarkers (S100β, BDNF, IL-6, acetylcholine, and norepinephrine).
RESULTS: The high esketamine group showed significantly lower HADS-A and HADS-D scores than control group on POD1 and POD3. No significant differences were observed between the low esketamine group and the control group. The esketamine-treated groups showed lower pain VAS scores than the control group at 2 h and on the first day after operation. There were no significant differences among the three groups in CAM and MMSE scores. However, the high esketamine group had lower S100β and IL-6 levels, and higher BDNF levels postoperatively, while serum acetylcholine and norepinephrine were not significantly different.
CONCLUSIONS: A single intraoperative injection of 0.5 mg/kg esketamine can alleviate postoperative anxiety, depression, and pain to some extent. Although cognitive function behavioral evaluation did not show obvious benefits, it can also reduce the production of pro-inflammatory and brain injury-related factors while promoting the generation of brain-derived neurotrophic factor. Registration Trial registry: http://www.chictr.org.cn/; Identifier: ChiCTR2100047067.
METHODS: A prospective single center double blinded randomized placebo-controlled trial.
METHODS: Perioperative period; operating room, post anesthesia care unit and hospital ward.
METHODS: 129 adult patients that underwent elective non-cardiac thoracic surgery under general anesthesia.
METHODS: During the operation, pharmacologic prevention of postoperative negative emotion and early cognitive disorder with 0.2 mg/kg (Low esketamine group) and 0.5 mg/kg esketamine (High esketamine group) vs. placebo.
METHODS: Emotion and early cognitive performance were assessed on the day before surgery (POD-1), postoperative day 1 (POD1) and day 3 (POD3) using HADS-A, HADS-D, Pain Visual Analogue Scale (VAS), Confusion Assessment Method (CAM), Mini-Mental State Examination (MMSE), and serum biomarkers (S100β, BDNF, IL-6, acetylcholine, and norepinephrine).
RESULTS: The high esketamine group showed significantly lower HADS-A and HADS-D scores than control group on POD1 and POD3. No significant differences were observed between the low esketamine group and the control group. The esketamine-treated groups showed lower pain VAS scores than the control group at 2 h and on the first day after operation. There were no significant differences among the three groups in CAM and MMSE scores. However, the high esketamine group had lower S100β and IL-6 levels, and higher BDNF levels postoperatively, while serum acetylcholine and norepinephrine were not significantly different.
CONCLUSIONS: A single intraoperative injection of 0.5 mg/kg esketamine can alleviate postoperative anxiety, depression, and pain to some extent. Although cognitive function behavioral evaluation did not show obvious benefits, it can also reduce the production of pro-inflammatory and brain injury-related factors while promoting the generation of brain-derived neurotrophic factor. Registration Trial registry: http://www.chictr.org.cn/; Identifier: ChiCTR2100047067.
摘要：
目的：探讨麻醉期间单剂量艾氯胺酮注射液是否能改善非心脏开胸手术患者术后负性情绪和早期认知功能。
方法：一项前瞻性单中心双盲随机安慰剂对照试验。
方法：围手术期；手术室，麻醉后监护病房和医院病房。
方法：129名成年患者在全身麻醉下进行择期非心脏胸外科手术。
方法：在操作过程中，药物预防术后负性情绪和早期认知障碍0.2mg/kg（低艾氯胺酮组）和0.5mg/kg艾氯胺酮（高艾氯胺酮组）与安慰剂。
方法：在手术前一天（POD-1）评估情绪和早期认知能力，术后第1天（POD1）和第3天（POD3）使用HADS-A，HADS-D,疼痛视觉模拟评分（VAS），混淆评估方法（CAM），小型精神状态检查（MMSE），和血清生物标志物(S100β，BDNF,IL-6，乙酰胆碱，和去甲肾上腺素）。
结果：在POD1和POD3上，高艾氯胺酮组的HADS-A和HADS-D评分明显低于对照组。低艾氯胺酮组与对照组之间没有显着差异。艾氯胺酮治疗组在术后2h和第一天的疼痛VAS评分低于对照组。三组间CAM和MMSE评分差异无统计学意义。然而,高艾氯胺酮组的S100β和IL-6水平较低，术后BDNF水平较高，而血清乙酰胆碱和去甲肾上腺素无显著差异。
结论：术中单次注射0.5mg/kg艾氯胺酮可缓解术后焦虑，抑郁症,疼痛在某种程度上。尽管认知功能行为评估并没有显示出明显的益处,它还可以减少促炎和脑损伤相关因子的产生，同时促进脑源性神经营养因子的产生。注册试验注册表：http://www。chictr.org.cn/；标识符：ChiCTR2100047067。
方法：一项前瞻性单中心双盲随机安慰剂对照试验。
方法：围手术期；手术室，麻醉后监护病房和医院病房。
方法：129名成年患者在全身麻醉下进行择期非心脏胸外科手术。
方法：在操作过程中，药物预防术后负性情绪和早期认知障碍0.2mg/kg（低艾氯胺酮组）和0.5mg/kg艾氯胺酮（高艾氯胺酮组）与安慰剂。
方法：在手术前一天（POD-1）评估情绪和早期认知能力，术后第1天（POD1）和第3天（POD3）使用HADS-A，HADS-D,疼痛视觉模拟评分（VAS），混淆评估方法（CAM），小型精神状态检查（MMSE），和血清生物标志物(S100β，BDNF,IL-6，乙酰胆碱，和去甲肾上腺素）。
结果：在POD1和POD3上，高艾氯胺酮组的HADS-A和HADS-D评分明显低于对照组。低艾氯胺酮组与对照组之间没有显着差异。艾氯胺酮治疗组在术后2h和第一天的疼痛VAS评分低于对照组。三组间CAM和MMSE评分差异无统计学意义。然而,高艾氯胺酮组的S100β和IL-6水平较低，术后BDNF水平较高，而血清乙酰胆碱和去甲肾上腺素无显著差异。
结论：术中单次注射0.5mg/kg艾氯胺酮可缓解术后焦虑，抑郁症,疼痛在某种程度上。尽管认知功能行为评估并没有显示出明显的益处,它还可以减少促炎和脑损伤相关因子的产生，同时促进脑源性神经营养因子的产生。注册试验注册表：http://www。chictr.org.cn/；标识符：ChiCTR2100047067。
