Effects of esketamine used before the skin incision of patients with laparoscopic total hysterectomy on their postoperative depression and sleep quality
Objective:To investigate the application efficacy of esketamine used before the skin incision of patients with laparoscopic total hysterectomy(LTH)on their postoperative depression and sleep quality.Methods:From Februar-y2021 to May 2023,110 patients with LTH were selected and were randomly divided into two groups(55 cases in each group)by random number table.All these patients were given treated with the selective LTH under general anesthesia.The patients in observation group were given intravenous injection of esketamine 0.3 mg/kg before skin incision,and the pa-tients in control group were injected with the same dose of normal saline at the same time point.The scores of Hamilton de-pression scale-17(HAMD-17),numeric rating scales(NRS)and Pittsburgh sleep quality index(PSQI)of the patients in the two groups at each time point were calculated.The levels of the serum neurotransmitters,such as dopamine(DA),epinephrine(E),norepinephrine(NE),of the patients were compared between the two groups.And the adverse reaction rates of the patients in the two groups were counted.Results:In observation group,53 patients were included for analysis after excluding 1 case of conversion to open surgery and 1 case of with-drawal due to person-al factors.In control group,1 patient with incomplete data was excluded,and 54 patients were included for analysis.The NRS scores at rest of the patients at 4 h,12 h,24 h,48 h after operation in observation group were 2.27±0.36 points,2.53±0.41 points,2.40±0.30 points and 2.12±0.32 points,respectively,which were significantly lower than those(2.62±0.40 points,3.08±0.46 points,2.85±0.38 points and 2.52±0.42 points)of the patients in control group.The HAMD-17 score in the 2nd day and in the 5th day after operation(13.24±2.16 points and 10.16±2.42 points)and the PSQI score in the 2nd day and in the 5th day after operation(12.46±1.84 points and 9.35 士 1.75 points)of the patients in observation group were significantly lower than those(15.07±2.33 points and 11.59±2.51 points,13.85±2.13 points and 10.08±1.92 points)of the patients in control group.The levels of serum norepinephrine(NE)(129.45±17.25 ng/L),epinephrine(E)(33.46±5.42 ng/L)and DA(7.02±1.16μg/L)of the patients in observa-tion group in the 5th day after operation were significantly higher than those(113.62±13.48 ng/L,30.72±4.15 ng/L,7.03±0.72μg/L)of the patients in control group(all P＜0.05).There was no significant difference in the total inci-dence of the adverse reactions of the patients between the observation group(17.0％)and the control group(14.8％)(P＞0.05).Conclusions:Esketamine used before the skin incision of the patients with LTH can alleviate their postopera-tive pain,regulate their expression level of neurotransmitters,and improve their depression and sleep status,and with-out increasing the adverse reactions.
Laparoscopic total hysterectomyEsketamineDrug used before skin incisionDepressionSleep quality
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