艾司氯胺酮对后路腰椎融合术老年患者术后疲劳综合征的影响

doi:10.12092/j.issn.1009-2501.2026.01.007

中国临床药理学与治疗学 ›› 2026, Vol. 31 ›› Issue (1): 63-71.doi: 10.12092/j.issn.1009-2501.2026.01.007

• 药物治疗学 • 上一篇

艾司氯胺酮对后路腰椎融合术老年患者术后疲劳综合征的影响

张从利¹(), 闫妍¹, 宋楠楠¹, 刘娣¹, 张阳¹, 周平辉², 任丽³, 范方田⁴^,*()

1. 蚌埠医科大学第一附属医院麻醉科，蚌埠 233004，安徽
2. 蚌埠医科大学第一附属医院骨科，蚌埠 233004，安徽
3. 蚌埠医科大学检验医学院，蚌埠 233030，安徽
4. 蚌埠医科大学药学院，蚌埠 233030，安徽

收稿日期:2024-08-01 修回日期:2024-10-30 出版日期:2026-01-26 发布日期:2026-02-13
通讯作者: 范方田 E-mail:byfy1010@163.com;fftian3912@163.com
作者简介:张从利，男，博士，主任医师，副教授，硕士生导师，研究方向：麻醉与围术期器官保护。E-mail：byfy1010@163.com
基金资助:
国家自然科学基金项目（81973658）；安徽省高校自然科学重点项目（2025AHGXZK30675和2024AH051250）；安徽省卫生健康科研项目（AHWJ2024Aa10058）；安徽省高校中青年教师培养行动项目（JNFX2024038）；贝恩麻醉科学研究项目（bnmr-2024-008）；蚌埠医科大学自然科学面上项目（2024byzd030）；蚌埠医科大学第一附属医院新技术项目（2023062）；蚌埠医科大学研究生科研创新计划项目（Byycx24053）

Effect of esketamine on postoperative fatigue syndrome in elderly patients undergoing posterior lumbar fusion

Congli ZHANG¹(), Yan YAN¹, Nannan SONG¹, Di LIU¹, Yang ZHANG¹, Pinghui ZHOU², Li REN³, Fangtian FAN⁴^,*()

1. Department of Anesthesiology, The First Affiliated Hospital of Bengbu Medical University, Bengbu 233004, Anhui, China
2. Department of Orthopaedics, The First Affiliated Hospital of Bengbu Medical University, Bengbu 233004, Anhui, China
3. College of Laboratory Medicine, Bengbu Medical University, Bengbu 233030, Anhui, China
4. College of Pharmacy, Bengbu Medical University, Bengbu 233030, Anhui, China

Received:2024-08-01 Revised:2024-10-30 Online:2026-01-26 Published:2026-02-13
Contact: Fangtian FAN E-mail:byfy1010@163.com;fftian3912@163.com

摘要/Abstract

摘要：

目的: 探讨艾司氯胺酮对后路腰椎融合术老年患者术后疲劳综合征（POFS）、恢复质量及细胞免疫的影响。方法: 选取择期行后路腰椎融合术老年患者128例，随机分为艾司氯胺酮组（Esk组，n=64）和生理盐水组（NS组，n=64）。两组患者术前均在超声引导下行改良胸腰筋膜平面（MTLIP）阻滞。Esk组，麻醉诱导时静脉推注0.25 mg/kg艾司氯胺酮，随后以0.125 mg·kg^?1·h^?1的剂量持续输注至手术结束前10 min。NS组，以同样的方法输注等量生理盐水。分别于术前1 d（D0）和术后1 d（D1）、3 d（D3）、7 d（D7）、30 d（D30）对患者进行简明围术期疲劳评定量表（ICFS-10）和恢复质量量表（QoR-15）评分，并统计患者POFS发生率。分别于麻醉诱导前（T0）、手术结束即刻（T1）和术后12 h（T2）、24 h（T3）、48 h（T4）、72 h（T5）采集外周静脉血，检测血清IL-6、IL-10、CD3⁺、CD4⁺、CD8⁺及CD4⁺/CD8⁺水平。记录术中麻醉药物用量、拔管时间、PACU停留时间、术后住院天数及术后恶心/呕吐及疼痛情况。结果: 与NS组比较，Esk组患者术后1 d的POFS发生率明显降低（53.3% vs. 32.8%，P=0.022）。术后1 d、3 d和7 d的ICFS-10评分明显降低（P<0.05），QoR-15评分显著升高（P<0.01）。T1-T2时，IL-6和CD8⁺水平明显降低（P<0.05），T1-T3时，IL-10水平明显升高（P<0.05），T1-T4时，CD3⁺和CD4⁺及CD4⁺/CD8⁺水平明显升高（P<0.05）。术中舒芬太尼、瑞芬太尼和丙泊酚的消耗量及呼气末七氟醚浓度明显降低，术后48 h恶心/呕吐发生率明显降低（P<0.05），术后呼吸机辅助时长、PACU停留时长和术后住院时长明显缩短。结论: 艾司氯胺酮可降低后路腰椎融合术老年患者POFS发生率、提高恢复质量，其机制可能与抑制炎性反应、改善细胞免疫功能有关。

关键词: 艾司氯胺酮, 腰椎融合术, 老年患者, 术后疲劳综合征

Abstract:

AIM: To investigate the effects of esketamine on postoperative fatigue syndrome (POFS), recovery quality and cellular immunity in elderly patients undergoing posterior lumbar fusion. METHODS: A total of 128 elderly patients scheduled for posterior lumbar fusion were randomly divided into esketamine group (Esk group, n=64) and normal saline group (NS group, n=64). Both groups underwent MTLIP block under ultrasound guidance before surgery. In the Esk group, 0.25 mg/kg esketamine was injected intravenously during anesthesia induction, followed by continuous infusion at 0.125 mg·kg^?1·h^?1 until 10 min before the end of surgery. In the NS group, equal-volume normal saline was injected in the same way. The concise perioperative Fatigue Rating Scale (ICFS-10) and Quality of Recovery Scale (QoR-15) were scored 1 day before surgery (D0), 1 day after surgery (D1), 3 days after surgery (D3), 7 days after surgery (D7) and 30 days after surgery (D30), respectively, and the incidence of POFS was analyzed. Peripheral venous blood samples were collected before anesthesia induction (T0), immediately after surgery (T1), 12 hours after surgery (T2), 24 hours after surgery (T3), 48 hours after surgery (T4) and 72 hours after surgery (T5), and the serum levels of IL-6, IL-10, CD3⁺, CD4⁺, CD8⁺ and CD4⁺/CD8⁺ were detected. The intraoperative anesthetic drug consumption, extubation time, PACU stay time, postoperative hospital stay, postoperative nausea/vomiting and pain were recorded. RESULTS: Compared with the NS group, the incidence of POFS in the Esk group was significantly decreased on day 1 after surgery (53.3% vs. 32.8%, P=0.022), the ICFS-10 scores of the Esk group were significantly decreased at 1, 3 and 7 days after surgery (P<0.05), the QoR-15 score was significantly increased (P<0.01). The levels of IL-6 and CD8⁺ were significantly decreased at T1-T2 (P<0.05). The level of IL-10 was significantly increased at T1-T3 (P<0.05). The levels of CD3⁺, CD4⁺ and CD4⁺/CD8⁺ increased significantly at T1-T4 (P<0.05). The consumption of sufentanil, remifentanil and propofol during operation and the end-tidal concentration of sevoflurane were significantly reduced. The incidence of nausea/vomiting was significantly decreased 48 hours after surgery (P<0.05). The duration of postoperative ventilator assistance, PACU stay and postoperative hospitalization were significantly shortened. CONCLUSION: Esketamine can reduce the incidence of POFS and improve the quality of recovery in elderly patients with posterior lumbar fusion, and its mechanism may be related to inhibiting inflammatory response and improving cellular immune function.

Key words: esketamine, lumbar fusion, elderly patients, postoperative fatigue syndrome

中图分类号:

R614

张从利, 闫妍, 宋楠楠, 刘娣, 张阳, 周平辉, 任丽, 范方田. 艾司氯胺酮对后路腰椎融合术老年患者术后疲劳综合征的影响[J]. 中国临床药理学与治疗学, 2026, 31(1): 63-71.

Congli ZHANG, Yan YAN, Nannan SONG, Di LIU, Yang ZHANG, Pinghui ZHOU, Li REN, Fangtian FAN. Effect of esketamine on postoperative fatigue syndrome in elderly patients undergoing posterior lumbar fusion[J]. Chinese Journal of Clinical Pharmacology and Therapeutics, 2026, 31(1): 63-71.

图/表 4

参考文献 30

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Item	Esk group (n=61)	NS group (n=60)	P-value
Age, median (IQR, y)	71(69-74)	72(69-75)	0.099
Female	33(54.1)	31(51.7)	0.789
BMI, median (IQR, kg/m²)	23.5(21.35-25.85)	22.85(21.25-24.45)	0.148
ASA grade (II/III)	21(34.4)/40(65.6)	26(43.3)/34(56.7)	0.315
Hypertension	36(59.0)	30(50)	0.319
Diabetes	10(16.4)	13(21.7)	0.460
Coronary atherosclerotic heart disease	6(9.8)	5(8.3)	0.774

Item	Esk group (n=61)	NS group (n=60)	P-value
Age, median (IQR, y)	71(69-74)	72(69-75)	0.099
Female	33(54.1)	31(51.7)	0.789
BMI, median (IQR, kg/m²)	23.5(21.35-25.85)	22.85(21.25-24.45)	0.148
ASA grade (II/III)	21(34.4)/40(65.6)	26(43.3)/34(56.7)	0.315
Hypertension	36(59.0)	30(50)	0.319
Diabetes	10(16.4)	13(21.7)	0.460
Coronary atherosclerotic heart disease	6(9.8)	5(8.3)	0.774

Item	Esk group (n=61)	NS group (n=60)	OR or MD (95% CI)	P -value
Anaesthetics and analgesics, median (IQR)
Sufentanil (μg)	40(35-40)	50(45-50)	10(5-10)	<0.001
Remifentanil (mg)	0.6(0.5-0.8)	0.9(0.6-1.0)	0.20(0.10-0.30)	<0.001
Propofol (mg)	120(90-140)	135(105-159)	15(0-30)	0.011
End-expiratory concentration of sevoflurane (%)
Skin incision	0.93(0.74-1.17)	0.90(0.75-1.38)	0.05(?0.07-0.16)	0.265
30 min of operation	0.65(0.53-0.74)	0.87(0.73-0.97)	0.22(0.15-0.27)	<0.001
60 min of operation	0.50(0.42-0.61)	0.87(0.71-0.95)	0.31(0.25-0.37)	<0.001
Length of surgery (min, median)	126(101-143.5)	130(102.5-148.75)	4(?11-14)	0.709
Duration of postoperative ventilator assistance (min)	28(26-36)	35.5(28-40)	4(1-7)	0.008
Length of PACU stay (min)	53(46.5-58.5)	64(57-67)	9(7-12)	<0.001
Length of postoperative hospital stay (d)	6(5-7)	7 (6-8)	1(0-1)	0.010

Item	Esk group (n=61)	NS group (n=60)	OR or MD (95% CI)	P -value
Anaesthetics and analgesics, median (IQR)
Sufentanil (μg)	40(35-40)	50(45-50)	10(5-10)	<0.001
Remifentanil (mg)	0.6(0.5-0.8)	0.9(0.6-1.0)	0.20(0.10-0.30)	<0.001
Propofol (mg)	120(90-140)	135(105-159)	15(0-30)	0.011
End-expiratory concentration of sevoflurane (%)
Skin incision	0.93(0.74-1.17)	0.90(0.75-1.38)	0.05(?0.07-0.16)	0.265
30 min of operation	0.65(0.53-0.74)	0.87(0.73-0.97)	0.22(0.15-0.27)	<0.001
60 min of operation	0.50(0.42-0.61)	0.87(0.71-0.95)	0.31(0.25-0.37)	<0.001
Length of surgery (min, median)	126(101-143.5)	130(102.5-148.75)	4(?11-14)	0.709
Duration of postoperative ventilator assistance (min)	28(26-36)	35.5(28-40)	4(1-7)	0.008
Length of PACU stay (min)	53(46.5-58.5)	64(57-67)	9(7-12)	<0.001
Length of postoperative hospital stay (d)	6(5-7)	7 (6-8)	1(0-1)	0.010

Item	Esk group (n=61)	NS group (n=60)	OR or MD (95% CI)	P -value
Primary outcome
Incidence of POFS
1 d after surgery	20(32.8)	32(53.3)	0.43(0.20-0.89)	0.022
3 d after surgery	19(31.1)	26(43.3)	0.59(0.28-1.25)	0.166
7 d after surgery	12(19.7)	18(30.0)	0.57(0.25-1.32)	0.188
30 d after surgery	2(3.3)	3(5.0)	0.64(0.10-4.00)	0.634
Secondary outcomes
ICFS-10 score, median (IQR)
1 d before surgery	17(15-18)	16(15-18)	0(?1-1)	0.577
1 d after surgery	22(20-28)	27(21-37)	3(1-7)	0.001
3 d after surgery	22(18.5-29)	23(21-35)	2(0-5)	0.013
7 d after surgery	21(18.5-24)	23(21-28)	2(0-4)	0.014
30 d after surgery	17(15-20)	17(16-19)	0(?1-1)	0.550
QoR-15 score, median (IQR)
1 d before surgery	128(125-131)	128(125-130)	?1(?2-1)	0.402
1 d after surgery	85(83-87)	80.5(78.3-85)	?4(?5-?3)	<0.001
3 d after surgery	96(91-100.5)	90(88-94.8)	?5(?7-?3)	<0.001
7 d after surgery	117(114-119)	110.5(108-113)	?6(?8-?5)	<0.001
30 d after surgery	126(120-132)	126(120-131)	?1(?3-1)	0.488
Postoperative adverse reactions
Nausea/Vomiting (0-48 h)	7(11.5)	17(28.3)	0.33(0.13-0.86)	0.020
Pain scores at 24 h (NRS), median (IQR)	2(0-2)	2(0-2.8)	0(0-0)	0.761
Pain scores at 48 h (NRS), median (IQR)	0(0-1)	0(0-1)	0(0-0)	0.672

艾司氯胺酮对后路腰椎融合术老年患者术后疲劳综合征的影响

Effect of esketamine on postoperative fatigue syndrome in elderly patients undergoing posterior lumbar fusion

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Item	T0	T1	T2	T3	T4	T5
IL-6 (pg/mL)
Esk group	8.4±1.0	11.2±2.2	12.6±3.6	17.4±4.0	15.8±4.3	12.9±3.3
NS group	8.5±0.9	12.6±4.1	15.1±5.1	18.1±5.8	16.7±3.9	13.8±3.8
t	?0.693	?2.409	?3.125	?0.814	?1.193	?1.326
p	0.490	0.018	0.002	0.417	0.235	0.187
IL-10 (pg/mL)
Esk group	4.9±0.9	8.9±1.7	11.1±2.5	12.9±3.7	13.4±3.0	9.7±2.4
NS group	4.9±1.3	6.9±1.7	9.4±2.0	11.6±2.7	12.5±2.7	9.0±1.9
t	?0.148	6.215	4.352	2.198	1.906	1.801
p	0.883	<0.001	<0.001	0.030	0.059	0.074
CD3⁺ (%)
Esk group	68.8±9.8	64.5±10.9	61.8±11.9	56.3±10.2	62.3±8.4	66.7±9.6
NS group	67.4±8.4	59.9±12.0	56.4±10.4	51.8±8.9	58.0±12.7	63.9±9.5
t	0.833	2.211	2.671	2.589	2.211	1.640
p	0.407	0.029	0.009	0.011	0.029	0.104
CD4⁺ (%)
Esk group	38.9±8.7	34.3±9.3	33.2±9.7	31.5±9.5	34.5±9.0	37.5±8.3
NS group	38.1±10.0	30.0±10.9	29.3±12.6	26.5±8.6	30.7±9.4	34.6±8.6
t	0.478	2.336	1.908	3.016	2.240	1.844
p	0.634	0.021	0.018	0.003	0.027	0.068
CD8⁺ (%)
Esk group	29.6±3.5	25.7±3.5	26.0±4.9	26.7±6.0	27.8±6.0	27.4±5.1
NS group	29.1±4.5	28.0±5.2	28.5±6.9	27.9±9.8	28.0±6.2	28.5±4.2
t	0.718	?2.892	?2.272	?0.769	?1.189	?1.294
p	0.474	0.005	0.025	0.444	0.851	0.198
CD4⁺/CD8⁺
Esk group	1.27±0.26	1.31±0.32	1.27±0.36	1.14±0.25	1.22±0.23	1.28±0.17
NS group	1.33±0.23	1.08±0.28	1.01±0.19	0.93±0.19	1.10±0.25	1.23±0.21
t	?1.464	4.279	4.795	5.283	2.685	1.496
p	0.146	<0.001	<0.001	<0.001	0.008	0.137

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