Efficacy of dexmedetomidine combined with esketamine in the treatment of patients with intractable insomnia and depression
Objective To evaluate the clinical efficacy of dexmedetomidine combined with esket-amine in the treatment of intractable insomnia with depression.Methods Sixty-eight patients,26 males and 42 females,aged 18-64 years,BMI 18-28 kg/m2,ASA physical status Ⅰ or Ⅱ,with intractable in-somnia and depression were selected.The patients were randomly divided into two groups:dexmedetomidine combined with esketamine group(group DE)and dexmedetomidine combined with normal saline group(group DS),34 patients in each group.All patients were treated with anesthesia-induced sleeping balance for three courses.The two groups were given dexmedetomidine 1 μg/kg by micro-pump injection for 10 mi-nutes to induce sleep,followed by dexmedetomidine 0.2-1.5 μg·kg-1·h-1 to maintain sleep.Group DE was injected with esketamine 0.5 mg/kg and normal saline was injected simultaneously in group DS.Before pre-first treatment(T0),after the first course of treatment(T1),after the second course of treatment(T2)and after the third course of treatment(T3),the Pittsburgh sleep quality index(PSQI)and insomnia sever-ity index(ISI)were used to evaluated sleeping quality,the Hamilton depression scale(HAMD)and the visual analogue scale for depression(VAS-D)were utilized to assess depression severity,the alternations of Hamilton anxiety scale(HAMA)and serum cortisol levels were also analyzed.The clinical efficacy evalua-tion at T3 compared with that at T0,and the occurrence of adverse reactions such as respiratory depression,nausea,vomiting,chest tightness,bradycardia,hypotension,anxiety,dissociation symptoms,stupor and nightmares were recorded during treatment.Results Compared with group DS,the PSQI and ISI scores were significantly decreased at T2 and T3 in group DE(P＜0.05),HAMD and VAS-D scores decreased significantly at T1,T2,and T3(P＜0.05),HAMA score and serum cortisol concentration were significant-ly decreased at T3(P＜0.05),the total effective rate was significantly increased at T3(P＜0.05).There was no significant difference in the incidence of adverse effects between the two groups.Conclusion Dexmedetomidine combined with esketamine can significantly improve the sleeping quality,symptoms of de-pression and anxiety of patients with intractable insomnia and depression and there were no obviousadverse reactions.
万方数据
维普
