艾司氯胺酮对肿瘤患者免疫功能的影响
Effect of Esketamine on Immune Function of Tumor Patients
DOI: 10.12677/acm.2025.15123381, PDF,   
作者: 张一铮, 李晓航：山东大学齐鲁第二医院麻醉科，山东 济南；金延武*：山东大学齐鲁第二医院麻醉科，山东 济南；山东省公共卫生临床中心，山东 济南
关键词: 艾司氯胺酮；免疫功能；肿瘤；临床麻醉；Esketamine； Immune Function； Tumor； Clinical Anesthesia
摘要: 近年来，肿瘤发病率持续攀升，不仅对民众生命构成严重威胁，也给社会经济造成了沉重负担。目前手术仍是治疗多种恶性肿瘤的主要方式，然而手术、麻醉及围术期其他因素等都会引起患者免疫抑制，导致术后肿瘤转移复发、术后愈合障碍及术后感染等并发症。自1962年问世以来，氯胺酮作为一种兼具镇痛作用的非巴比妥类静脉麻醉药，在临床麻醉与镇静领域得到了广泛应用，其作用机制主要与拮抗N-甲基-D-天冬氨酸受体(NMDA受体)有关，此外还与作用于多巴胺能、5-羟色胺能、肾上腺素能、阿片能、胆碱能、σ受体等有关。艾司氯胺酮是从氯胺酮中分离提纯出的右旋体，其镇静镇痛及抗抑郁作用比氯胺酮更强，而精神反应等副作用则较少。最近，关于艾司氯胺酮的研究越来越多，在临床上的使用也逐渐受到重视。然而，尚未就其在肿瘤患者免疫功能产生的影响达成共识。本文综述了近年来艾司氯胺酮对免疫功能的临床研究，旨在为艾司氯胺酮对肿瘤患者免疫功能的影响提供借鉴和参考。
Abstract: In recent years, the incidence of cancer has been steadily increasing, posing not only a severe threat to people’s lives but also imposing a substantial economic burden on society. Currently, surgery remains the primary treatment modality for various malignant tumors. However, factors such as surgery, anesthesia, and other perioperative elements can induce immunosuppression in patients, leading to postoperative complications including tumor metastasis and recurrence, impaired wound healing, and infections. Since its introduction in 1962, ketamine, a non-barbiturate intravenous anesthetic with analgesic properties, has found widespread application in clinical anesthesia and sedation. Its mechanism of action primarily involves antagonism of the N-methyl-D-aspartate receptor (NMDA receptor), and is also associated with effects on dopaminergic, serotonergic, adrenergic, opioid, cholinergic, and sigma receptors, among others. Esketamine, the dextrorotatory enantiomer isolated and purified from ketamine, exhibits stronger sedative, analgesic, and antidepressant effects compared to ketamine, while causing fewer side effects such as psychiatric reactions. Recently, there has been a surge in research on esketamine, and its clinical use has garnered increasing attention. Nevertheless, a consensus has yet to be reached regarding its impact on the immune function of cancer patients. This article reviews recent clinical studies on the effects of esketamine on immune function, aiming to provide insights and references for understanding its influence on the immune function of cancer patients.
文章引用：张一铮, 李晓航, 金延武. 艾司氯胺酮对肿瘤患者免疫功能的影响[J]. 临床医学进展, 2025, 15(12): 69-76. https://doi.org/10.12677/acm.2025.15123381

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