艾司氯胺酮对老年患者术后谵妄的影响及机制研究进展

Research Progress on the Effects and Mechanisms of Esketamine for Postoperative Delirium in Elderly Patients

摘要: 术后谵妄是老年患者常见的手术并发症，严重影响术后康复及长期认知功能。艾司氯胺酮作为氯胺酮的右旋异构体，具有强效的N-甲基-D-天冬氨酸受体拮抗作用，兼具抗炎、抗氧化及神经保护等多重机制，近年来其在防治术后谵妄方面的潜力受到广泛关注。本文系统综述了艾司氯胺酮对老年患者术后谵妄的影响及其作用机制，重点探讨其在拮抗谷氨酸兴奋性毒性、调节小胶质细胞极化、抑制神经炎症反应、改善突触可塑性等方面的神经保护作用。临床研究显示，小剂量艾司氯胺酮在部分手术中可降低谵妄发生率并改善早期认知功能，但也有研究认为其效果不显著甚至可能增加谵妄风险，存在剂量与给药方式的争议。艾司氯胺酮在防治老年患者术后谵妄方面具有一定潜力，但其最佳用药策略及具体机制仍需进一步高质量研究予以明确。

Abstract: Postoperative delirium is a common surgical complication in elderly patients, seriously affecting postoperative recovery and long-term cognitive function. Esketamine, the dextrorotatory isomer of ketamine, possesses potent N-methyl-D-aspartate receptor antagonism and exhibits multiple mechanisms including anti-inflammatory, antioxidant, and neuroprotective effects. Its potential in preventing and treating postoperative delirium has garnered significant attention in recent years. This article systematically reviews the effects of esketamine on postoperative delirium in elderly patients and its mechanisms of action, focusing on its neuroprotective effects in antagonizing glutamate excitotoxicity, regulating microglial polarization, inhibiting neuroinflammatory responses, and improving synaptic plasticity. Clinical studies have shown that low-dose esketamine can reduce the incidence of delirium and improve early cognitive function in some surgeries; however, other studies suggest that its effects are not significant and may even increase the risk of delirium, indicating controversy regarding dosage and administration methods. Esketamine shows potential in preventing and treating postoperative delirium in elderly patients, but its optimal administration strategy and specific mechanisms require further high-quality research to clarify.