老年患者围手术期应用艾氯胺酮的临床获益与挑战。

IF 5.1 2区医学 Q1 CHEMISTRY, MEDICINAL

Drug Design, Development and Therapy Pub Date : 2025-09-13 eCollection Date: 2025-01-01 DOI:10.2147/DDDT.S536813

Shuai Zhang, Chen Bai, Mingcan Xu, Yiqing Li, Ying Han, Yanwu Jin, Xin Zhao

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引用次数: 0

摘要

氯胺酮是一种典型的静脉麻醉剂。艾氯胺酮是氯胺酮的右旋异构体，其作用机制与氯胺酮相似，主要通过对n-甲基- d -天冬氨酸受体的非竞争性拮抗作用，效力更高，副作用更少。艾氯胺酮的特点包括循环刺激、支气管扩张、炎症抑制和解离麻醉特性。艾氯胺酮于2019年在中国获批临床使用，在儿科、孕产妇、老年人或休克患者中具有显著优势。艾氯胺酮的临床应用目前受到广泛关注。本文综述了艾氯胺酮在老年患者围手术期应用的临床研究进展及局限性，包括其药理学特性、血流动力学作用、镇痛作用以及对抑郁、睡眠和神经认知功能的影响，以期为艾氯胺酮在老年患者麻醉中的应用提供理论参考，并为老年患者提供剂量推荐。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

Clinical Benefits and Challenges of Esketamine in Elderly Patients During the Perioperative Period.

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Clinical Benefits and Challenges of Esketamine in Elderly Patients During the Perioperative Period.

Ketamine is a classic intravenous anesthetic. Esketamine is a dextro-isomer of ketamine, with similar mechanism of action, mainly through non-competitive antagonism of N-methyl-D-aspartate receptors, higher potency and fewer adverse effects. The characteristics of esketamine include circulatory stimulation, bronchodilatation, inhibition of inflammation and dissociative anesthetic properties. Esketamine was approved for clinical practice in China in 2019, and has significant advantages for use in pediatric, maternal, elderly or shock patients. The clinical use of esketamine is currently receiving widespread attention. This article reviews the recent progress and limitations of clinical studies on the perioperative use of esketamine in elderly patients, covering its pharmacological properties, hemodynamic effects, analgesic benefits, and impacts on depression, sleep, and neurocognitive function, to provide theoretical reference for its application in anesthesia and offer dosage recommendations for elderly patients.

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来源期刊

Drug Design, Development and Therapy CHEMISTRY, MEDICINAL-PHARMACOLOGY & PHARMACY

CiteScore

9.00

自引率

0.00%

发文量

382

审稿时长

>12 weeks

期刊介绍： Drug Design, Development and Therapy is an international, peer-reviewed, open access journal that spans the spectrum of drug design, discovery and development through to clinical applications. The journal is characterized by the rapid reporting of high-quality original research, reviews, expert opinions, commentary and clinical studies in all therapeutic areas. Specific topics covered by the journal include: Drug target identification and validation Phenotypic screening and target deconvolution Biochemical analyses of drug targets and their pathways New methods or relevant applications in molecular/drug design and computer-aided drug discovery* Design, synthesis, and biological evaluation of novel biologically active compounds (including diagnostics or chemical probes) Structural or molecular biological studies elucidating molecular recognition processes Fragment-based drug discovery Pharmaceutical/red biotechnology Isolation, structural characterization, (bio)synthesis, bioengineering and pharmacological evaluation of natural products** Distribution, pharmacokinetics and metabolic transformations of drugs or biologically active compounds in drug development Drug delivery and formulation (design and characterization of dosage forms, release mechanisms and in vivo testing) Preclinical development studies Translational animal models Mechanisms of action and signalling pathways Toxicology Gene therapy, cell therapy and immunotherapy Personalized medicine and pharmacogenomics Clinical drug evaluation Patient safety and sustained use of medicines.