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Objective <p>To investigate the association between perioperative esketamine use, postoperative acute lung injury (ALI), and macrophage polarization-related markers in patients undergoing acute type A aortic dissection (ATAAD) surgery.</p> Methods <p>A total of 124 patients with ATAAD treated at our hospital between January 2022 and December 2024 were retrospectively included. Postoperative ALI was assessed within the first 24&#xa0;h after ICU admission following ATAAD surgery, and patients were classified into the ALI group (<i>n</i> = 52) and non-ALI group (<i>n</i> = 72) accordingly. Univariate analysis and binary logistic regression were performed to identify factors associated with postoperative ALI after ATAAD surgery. Patients were further analyzed according to perioperative esketamine use to evaluate differences in macrophage polarization-related markers and clinical outcomes.</p> Results <p>Binary logistic regression analysis showed that hypertension was independently associated with an increased risk of postoperative ALI (OR = 5.586, 95% CI: 1.832–17.034, <i>P</i> = 0.002), whereas perioperative esketamine use was independently associated with a reduced risk of postoperative ALI (OR = 0.155, 95% CI: 0.061–0.394, <i>P</i> &lt; 0.001). After propensity score matching, 45 matched pairs were retained. In the matched cohort, postoperative ALI occurred in 11 patients in the esketamine group and 23 patients in the non-esketamine group (24.4% vs. 51.1%, <i>P</i> = 0.011). Perioperative esketamine use remained associated with a lower risk of postoperative ALI after matching (OR = 0.31, 95% CI: 0.13–0.74, <i>P</i> = 0.008). Patients in the esketamine group also showed a lower postoperative M1-related index and M1/M2 ratio, a higher M2-related index, and a shorter hospital stay.</p> Conclusion <p>Perioperative esketamine use was associated with a lower risk of postoperative ALI after ATAAD surgery and was accompanied by favorable changes in macrophage polarization-related markers. Given the retrospective single-center design and limited sample size, these findings should be interpreted cautiously and require validation in larger prospective studies.</p> Trial registration <p>Not applicable. This was a retrospective observational study and did not involve prospective assignment of participants to an intervention.</p>

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Association of esketamine with acute lung injury and macrophage polarization-related markers after ATAAD surgery

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年7月31日

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  • Xiangqian Cui,
  • Peng Jiang,
  • Xianhu Li,
  • Hexi Hou

摘要

Objective

To investigate the association between perioperative esketamine use, postoperative acute lung injury (ALI), and macrophage polarization-related markers in patients undergoing acute type A aortic dissection (ATAAD) surgery.

Methods

A total of 124 patients with ATAAD treated at our hospital between January 2022 and December 2024 were retrospectively included. Postoperative ALI was assessed within the first 24 h after ICU admission following ATAAD surgery, and patients were classified into the ALI group (n = 52) and non-ALI group (n = 72) accordingly. Univariate analysis and binary logistic regression were performed to identify factors associated with postoperative ALI after ATAAD surgery. Patients were further analyzed according to perioperative esketamine use to evaluate differences in macrophage polarization-related markers and clinical outcomes.

Results

Binary logistic regression analysis showed that hypertension was independently associated with an increased risk of postoperative ALI (OR = 5.586, 95% CI: 1.832–17.034, P = 0.002), whereas perioperative esketamine use was independently associated with a reduced risk of postoperative ALI (OR = 0.155, 95% CI: 0.061–0.394, P < 0.001). After propensity score matching, 45 matched pairs were retained. In the matched cohort, postoperative ALI occurred in 11 patients in the esketamine group and 23 patients in the non-esketamine group (24.4% vs. 51.1%, P = 0.011). Perioperative esketamine use remained associated with a lower risk of postoperative ALI after matching (OR = 0.31, 95% CI: 0.13–0.74, P = 0.008). Patients in the esketamine group also showed a lower postoperative M1-related index and M1/M2 ratio, a higher M2-related index, and a shorter hospital stay.

Conclusion

Perioperative esketamine use was associated with a lower risk of postoperative ALI after ATAAD surgery and was accompanied by favorable changes in macrophage polarization-related markers. Given the retrospective single-center design and limited sample size, these findings should be interpreted cautiously and require validation in larger prospective studies.

Trial registration

Not applicable. This was a retrospective observational study and did not involve prospective assignment of participants to an intervention.