亚麻醉剂量艾司氯胺酮对老年髋关节置换术患者血清基质金属蛋白酶-9及术后谵妄的影响OA

AIM:To evaluate the effects of sub-anesthetic dose of esketamine on serum matrix metalloproteinase-9(MMP-9)and postoperative delirium(POD)in elderly patients undergoing hip replacement.METHODS:From February 2024 to March 2025,110 elderly patients aged 65-79 years undergoing elective hip replacement under general anesthesia in our hospital were randomly divided into esketamine group(group E,n=55)and control group(group C,n=55).Patients in group E were giv-en esketamine(loading dose 0.2 mg/kg,followed by continuous infusion at a rate of 0.1 mg·kg-1·h-1),while patients in group C were given an equal vol-ume of normal saline(loading dose 0.2 mL/kg,fol-lowed by continuous infusion at a rate of 0.1 mL·kg-1·h-1).POD was assessed by the confusion as-sessment method for the intensive care unit(CAM-ICU)at 3 days after operation.The serum concen-trations of MMP-9,interleukin-6(IL-6)and inter-leukin-1β(IL-1β)were detected by venous blood sampling before operation,1 d and 3 d after opera-tion.The quality of recovery was assessed using the 15-item quality of recovery questionnaire(QoR-15)at 1 and 2 days after surgery,and the time to first ambulation and length of hospital stay were record-ed.RESULTS:Compared with Group C,Group E showed a significantly lower incidence of POD(9.1%vs.23.6%,χ2=4.251,P=0.039),along with reduced severity(3.1±1.1 vs.4.2±1.6 score,t=4.201,P<0.001)and shorter duration of POD(1.1±0.7 vs.2.2±0.9 days,t=7.155,P<0.001).Serum concentra-tions of MMP-9,IL-6,and IL-1β in Group E were sig-nificantly lower than those in Group C at postopera-tive day 1 and day 3(all P<0.001).Compared to Group C,Group E demonstrated significantly higher QoR-15 scores[postoperative day 1:(114.1±7.4)vs.(91.3±5.3)score;postoperative day 2:(126.1±8.5)vs.(103.2±6.3)score,both P<0.001]and earlier am-bulation time(27.6±3.7 vs.31.4±3.3 h,P<0.001).The total incidence of intraoperative and postoper-ative adverse events was similar between the two groups(P>0.05).CONCLUSION:Subanesthetic-dose esketamine significantly reduces the incidence of POD and serum levels of MMP-9,IL-6,and IL-1β,im-proves postoperative recovery quality,and does not increase perioperative adverse events in elderly pa-tients undergoing hip replacement,providing an ef-fective strategy for optimizing anesthesia manage-ment in geriatric populations.