Effect of esketamine on postoperative cognitive function in elderly hip arthroplasty patients

doi:10.3877/cma.j.issn.1674-134X.2026.04.004

Abstract

Abstract:

Objective

To investigate the effect of esketamine on postoperative cognitive function in elderly hip arthroplasty patients.

Methods

This prospective study enrolled 114 elderly patients who underwent hip replacement surgery at Chengdu Western Hospital between December 2020 and December 2022. Inclusion criteria: age >60 years, American Society of Anesthesiologists (ASA) classification Ⅱ to Ⅲ, and undergoing unilateral hip replacement surgery. Exclusion criteria: severe cardiac, hepatic or renal insufficiency; history of allergy to anesthetic agents; severe psychiatric or neurological disorders; and long-term use of sedatives, anticoagulants, or similar medications. The patients were randomly assigned to two groups using a random number table, the control group and the intervention group with 57 patients in each. The control group received anesthesia with an equivalent volume of normal saline, while the intervention group received anesthesia with esketamine. Cognitive function was assessed using the mini-mental state examination (MMSE). Repeated-measures analysis of variance (ANOVA) was used to compare MMSE scores between the two groups on the day before surgery and on one, three and seven days after surgery; independent-sample t test was used to compare postoperative recovery outcomes (time to respiratory recovery, time to eye opening, time to first ambulation, and length of hospital stay) between the two groups; repeated-measures analysis of variance was used to compare heart rate (HR), mean arterial pressure (MAP), and Ramsay sedation scores between the two groups at five minutes before anesthesia induction (T0), at the time of induction (T1), one minute after intubation (T2), one minute after skin incision (T3), and at the end of surgery (T4). Independent-sample t test was used to compare stress response indicators between the two groups on the day before surgery and the day after surgery; and chi square test was used to analyze the incidence of adverse reactions in the two groups.

Results

The MMSE score of the study group was significantly higher than that of the control group on the first, third and seventh day after operation (t=9.394, 10.719, 6.352, all P<0.05). There was no statistically significant difference between the two groups in respiratory recovery time, time to open eyes and time to get out of bed for the first time (all P>0.05). Compared with the control group, the hospitalization time of the study group was significantly shorter (t=2.994, P<0.05), and the postoperative delirium rate of the study group (8.8% vs 29.8%) was significantly lower (χ²=8.111, P<0.05). Ramsay sedation score in the study group was significantly higher than that in the control group at T1, T2, T3 and T4 (t=7.363, 6.062, 16.187, 15.735, all P<0.05). The levels of epinephrine, norepinephrine, factor-α (TNF-α), C-reactive protein (CRP), and interleukin (IL) -6 were lower in the study group than in the control group at one day after operation (t=6.063, 3.865, 2.582, 9.083, 2.810, all P<0.05). The incidence of adverse reactions between the study group and the control group (40.3% vs 38.6%) was not statistically significant (P>0.05).

Conclusion

The application of esketamine in elderly patients with hip arthroplasty can effectively reduce the stress response, improve the sedation effect, reduce the postoperative cognitive impairment, and promote the early recovery of patients.

Key words: Aged, Anesthesia, Arthroplasty, replacement hip, Stress, physiological, Cognitive dysfunction

Xiaoying Pei, Qiang Zhou, Jun Peng, Bo Liu. Effect of esketamine on postoperative cognitive function in elderly hip arthroplasty patients[J]. Chinese Journal of Joint Surgery(Electronic Edition), 2026, 20(04): 423-430.

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URL: https://zhgjwkzz.cma-cmc.com.cn/EN/10.3877/cma.j.issn.1674-134X.2026.04.004

https://zhgjwkzz.cma-cmc.com.cn/EN/Y2026/V20/I04/423

Figures/Tables 6

Table 1 Comparison of baseline characteristics between the two groups

组别 Groups	例数 Number of cases	年龄［岁，（ $x ¯$ ±s）］ Age（year）	性别［n（%）］ Gender		BMI ［kg/m²，（ $x ¯$ ±s）］	ASA分级［n（%）］ ASA classification
组别 Groups	例数 Number of cases	年龄［岁，（ $x ¯$ ±s）］ Age（year）	男Male	女Female	BMI ［kg/m²，（ $x ¯$ ±s）］	Ⅱ级	Ⅲ级
研究组 Experimental group	57	71.6±6.3	23（40.3）	34（59.7）	21.1±2.7	38（66.7）	19（33.3）
对照组 Control group	57	72.3±7.2	20（35.1）	37（64.9）	20.5±2.7	41（71.9）	16（28.1）
统计值 Statistical values		t=0.523	χ²=0.336		t=1.336	χ²=0.371
P值		＞0.05	＞0.05		＞0.05	＞0.05
组别 Groups	例数 Number of cases	糖尿病［n（%）］ Diabetes	文化程度［n（%）］ Education		高血压［n（%）］ High blood pressure	手术时间［min，（ $x ¯$ ±s）］ Surgery time	ICU停留时间［min，（ $x ¯$ ±s）］ Length of ICU stay
组别 Groups	例数 Number of cases	糖尿病［n（%）］ Diabetes	初中及以下 Junior school or below	高中及以上 High school or above	高血压［n（%）］ High blood pressure	手术时间［min，（ $x ¯$ ±s）］ Surgery time	ICU停留时间［min，（ $x ¯$ ±s）］ Length of ICU stay
研究组 Experimental group	57	10（17.5）	43（75.4）	14（24.6）	33（57.9）	98.7±15.4	24.3±6.6
对照组 Control group	57	9（15.8）	41（71.9）	16（28.1）	35（61.4）	102.0±16.8	25.1±6.3
统计值 Statistical values		χ²=0.063	χ²=0.181		χ²=0.146	t=1.123	t=0.702
P值		＞0.05	＞0.05		＞0.05	＞0.05	＞0.05

Table 1 Comparison of baseline characteristics between the two groups

组别 Groups	例数 Number of cases	年龄［岁，（ $x ¯$ ±s）］ Age（year）	性别［n（%）］ Gender		BMI ［kg/m²，（ $x ¯$ ±s）］	ASA分级［n（%）］ ASA classification
组别 Groups	例数 Number of cases	年龄［岁，（ $x ¯$ ±s）］ Age（year）	男Male	女Female	BMI ［kg/m²，（ $x ¯$ ±s）］	Ⅱ级	Ⅲ级
研究组 Experimental group	57	71.6±6.3	23（40.3）	34（59.7）	21.1±2.7	38（66.7）	19（33.3）
对照组 Control group	57	72.3±7.2	20（35.1）	37（64.9）	20.5±2.7	41（71.9）	16（28.1）
统计值 Statistical values		t=0.523	χ²=0.336		t=1.336	χ²=0.371
P值		＞0.05	＞0.05		＞0.05	＞0.05
组别 Groups	例数 Number of cases	糖尿病［n（%）］ Diabetes	文化程度［n（%）］ Education		高血压［n（%）］ High blood pressure	手术时间［min，（ $x ¯$ ±s）］ Surgery time	ICU停留时间［min，（ $x ¯$ ±s）］ Length of ICU stay
组别 Groups	例数 Number of cases	糖尿病［n（%）］ Diabetes	初中及以下 Junior school or below	高中及以上 High school or above	高血压［n（%）］ High blood pressure	手术时间［min，（ $x ¯$ ±s）］ Surgery time	ICU停留时间［min，（ $x ¯$ ±s）］ Length of ICU stay
研究组 Experimental group	57	10（17.5）	43（75.4）	14（24.6）	33（57.9）	98.7±15.4	24.3±6.6
对照组 Control group	57	9（15.8）	41（71.9）	16（28.1）	35（61.4）	102.0±16.8	25.1±6.3
统计值 Statistical values		χ²=0.063	χ²=0.181		χ²=0.146	t=1.123	t=0.702
P值		＞0.05	＞0.05		＞0.05	＞0.05	＞0.05

Table 2 Comparison of MMSE scores between the two goups a at different time points

组别 Groups	例数 Number of cases	术前1 d One day before surgery	术后1 d One day after surgery	术后3 d Three days after surgery	术后7 d Seven days after surgery
研究组 Experimental group	57	27.7±1.0	24.9±1.2	26.5±1.1	27.5±1.3
对照组 Control group	57	27.6±1.0	22.8±1.2	24.3±1.1	26.0±1.3
F值		组间：77.400；时间：472.537；交互：38.573
P值		均为＜0.001
t值		0.65	9.394	10.719	6.352
P值		＞0.05	＜0.001	＜0.001	＜0.001

Table 3 Comparison of postoperative recovery between the two groups

组别 Groups	例数 Number of cases	呼吸恢复时间［min，（ $x ¯$ ±s）］ Time to resume breathing	睁眼时间［min，（ $x ¯$ ±s）］ Time to open eyes	首次下床时间［h，（ $x ¯$ ±s）］ Time to first get out of bed	住院时间［d，（ $x ¯$ ±s）］ Length of hospital stay	谵妄［n（%）］ Delirium
研究组 Experimental group	57	11.1±3.0	9.5±2.4	20.5±2.4	7.7±2.5	5（8.8）
对照组 Control group	57	10.9±3.1	9.7±2.5	21.3±3.2	8.9±2.1	17（29.8）
统计值 Statistical values		t=0.214	t=0.267	t=1.602	t=2.994	χ²=8.111
P值		＞0.05	＞0.05	＞0.05	＜0.01	＜0.01

Table 3 Comparison of postoperative recovery between the two groups

组别 Groups	例数 Number of cases	呼吸恢复时间［min，（ $x ¯$ ±s）］ Time to resume breathing	睁眼时间［min，（ $x ¯$ ±s）］ Time to open eyes	首次下床时间［h，（ $x ¯$ ±s）］ Time to first get out of bed	住院时间［d，（ $x ¯$ ±s）］ Length of hospital stay	谵妄［n（%）］ Delirium
研究组 Experimental group	57	11.1±3.0	9.5±2.4	20.5±2.4	7.7±2.5	5（8.8）
对照组 Control group	57	10.9±3.1	9.7±2.5	21.3±3.2	8.9±2.1	17（29.8）
统计值 Statistical values		t=0.214	t=0.267	t=1.602	t=2.994	χ²=8.111
P值		＞0.05	＞0.05	＞0.05	＜0.01	＜0.01

Table 4 Comparison of Ramsay sedation scores between the two groups at different time points

组别 Groups	例数 Number of cases	T0	T1	T2	T3	T4
研究组 Experimental group	57	2.0±0	2.9±1.0	3.0±1.0	3.5±0.8	3.5±0.8
对照组 Control group	57	2.0±0	2.0±0	1.9±0.9	1.5±0.5	1.5±0.5
F值		组间：236.228；时间：16.074；交互：58.060
P值		均为＜0.001
t值		0.000	7.363	6.062	16.187	15.735
P值		＞0.05	＜0.001	＜0.001	＜0.001	＜0.001

Table 5 Comparison on stress indicators one day before and after surgery between two groups

组别 Groups	例数 Number of cases	肾上腺素（pmol/L） Adrenalin		去甲肾上腺素（pmol/L） Noradrenaline‌			TNF-α（ng/ L）
组别 Groups	例数 Number of cases	术前 Before surgery	术后 After surgery	术前 Before surgery	术后 After surgery		术前 Before surgery	术后 After surgery
研究组 Experimental group	57	920.5±118.7	1240.4±176.0^a	2612.8±221.6	4092.0±375.0^a		13.9±3.3	15.6±3.1^b
对照组 Control group	57	942.5±103.9	1440.3±176.0^a	2621.0±206.9	4363.2±374.1^a		13.8±3.4	17.1±3.0^a
t值		1.049	6.063	0.204	3.865		0.127	2.582
P值		＞0.05	＜0.001	＞0.05	＜0.001		＞0.05	＜0.05
组别 Groups	例数 Number of cases	CRP（ng/ L）		IL-6（ng/L）		-	-
组别 Groups	例数 Number of cases	术前 Before surgery	术后 After surgery	术前 Before surgery	术后 After surgery	-	-
研究组 Experimental group	57	4.5±0.8	7.6±2.0^a	36.6±8.8^a	41.3±9.1^a	-	-
对照组 Control group	57	4.4±0.9	12.7±3.7^a	37.8±9.6^a	46.2±9.7^a	-	-
t值		0.197	9.083	0.683	2.810	-	-
P值		＞0.05	＜0.001	＞0.05	＜0.01	-	-

Table 6 Comparison of adverse reaction incidence between the two groups

组别 Groups	例数 Number of cases	窦性心动过缓 Sinus bradycardia	低血压 Hypotension	恶心呕吐 Nausea and vomiting	总不良反应 Overall adverse reactions
研究组 Experimental group	57	6（10.5）	9（15.8）	8（14.0）	23（40.3）
对照组 Control group	57	5（8.8）	7（12.3）	10（17.5）	22（38.6）
χ²值		0.101	0.291	0.264	0.037
P值		＞0.05	＞0.05	＞0.05	＞0.05

References 20

［1］	刘晓凡. 老年股骨头坏死髋关节置换术后康复应用多维度干预［J/OL］. 中华关节外科杂志（电子版）, 2024, 18（3）: 314－319.
［2］	吕清香, 范红卫. 不同麻醉方式对老年髋关节置换术后谵妄、苏醒期躁动及认知功能的影响［J］. 国际精神病学杂志, 2021, 48（3）: 488－491.
［3］	廖秀珊, 李耀松, 何晓华, 等. 超声引导下腰骶丛神经阻滞联合全身麻醉对老年髋关节置换术患者认知功能、氧化应激和血流动力学的影响［J］. 现代生物医学进展, 2021, 21（9）: 1729－1733.
［4］	Maldonado DR, Kyin C, Walker-Santiago R, et al. Direct anterior approach versus posterior approach in primary total hip replacement: comparison of minimum 2-year outcomes［J］. Hip Int, 2021, 31（2）: 166－173.
［5］	张真真, 周晓艳, 曹林, 等. 术前衰弱对行膝髋关节置换手术老年患者术后谵妄的影响［J］. 医学研究生学报, 2021, 34（4）: 371－374.
［6］	田春林, 涂青梅, 陈好亮, 等. 艾司氯胺酮的临床应用进展［J］. 河北医药, 2024, 46（8）: 1234－1238.
［7］	王丹君, 沈家豪, 王清秀. 艾司氯胺酮临床应用的研究进展［J］. 同济大学学报（医学版）, 2024, 45（1）: 158－164.
［8］	蓝金辛, 李森, 何俊冰, 等. 老年患者应用艾司氯胺酮麻醉的临床研究进展［J］. 中华老年多器官疾病杂志, 2024, 23（7）: 549－552.
［9］	向继林, 诸源江, 姚富, 等. 艾司氯胺酮麻醉诱导对下肢骨折患者围术期应激及不良反应的影响［J］. 创伤外科杂志, 2023, 25（11）: 863－867.
［10］	张治明, 肖裔兴, 秦苑, 等. 髋关节置换术后右美托咪定增强罗哌卡因的镇痛效果［J/OL］. 中华关节外科杂志（电子版）, 2021, 15（6）: 743－747.
［11］	Moon M, Oh EG, Baek W, et al. Effects of nurse-led pain management interventions for patients with total knee/hip replacement［J］. Pain Manag Nurs, 2021, 22（2）: 111－120.
［12］	杨子健, 黄铭颖, 刘湘钰, 等. 艾司氯胺酮复合咪达唑仑对老年髋关节置换术后谵妄的影响及对HT22细胞的作用［J］. 实用医学杂志, 2022, 38（19）: 2395－2399.
［13］	陶李, 孟杰, 肖航. 不同负荷量艾司氯胺酮联合腰麻对老年髋关节置换病人术后认知功能的影响［J］. 临床外科杂志, 2022, 30（6）: 532－534.
［14］	Barreto Chang OL, Kreuzer M, Morgen DF, et al. Ketamine-associated intraoperative electroencephalographic signatures of elderly patients with and without preoperative cognitive impairment［J］. Anesth Analg, 2022, 135（4）: 683－692.
［15］	李华, 张卓亮, 段陈夏, 等. 小剂量艾司氯胺酮复合舒芬太尼术后镇痛对老年患者髋关节置换术后早期认知功能的影响［J］. 临床麻醉学杂志, 2022, 38（9）: 936－939.
［16］	查敦鑫, 包明胜, 黄俊, 等. 老年髋关节置换术病人围术期艾司氯胺酮应用的安全性及有效性分析［J］. 蚌埠医学院学报, 2022, 47（7）: 862－865, 869.
［17］	Urvoy B, Aveline C, Belot N, et al. Opioid-free anaesthesia for anterior total hip replacement under general anaesthesia: the Observational Prospective Study of Opiate-free Anesthesia for Anterior Total Hip Replacement trial［J］. Br J Anaesth, 2021, 126（4）: e136－e139.
［18］	祁占花, 张建业, 范卫玲. 超声引导下髂筋膜联合腰骶丛神经阻滞对老年髋关节置换手术患者应激反应及谵妄的影响［J］. 医学综述, 2021, 27（7）: 1452－1456.
［19］	聂亮, 胡芸, 曾丽. 超声引导下髂筋膜间隙阻滞复合浅全麻在老年髋关节置换术中的麻醉效果及对术后恢复的影响［J］. 实用医院临床杂志, 2021, 18（4）: 212－216.
［20］	卜琰, 李欣洁. 全身麻醉与椎管内麻醉对老年髋关节置换术患者凝血功能的影响分析［J］. 血栓与止血学, 2021, 27（2）: 278－280.

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