小剂量艾司氯胺酮术后镇痛对胃肠道肿瘤患者术后抑郁的影响
Effect of low-dose esketamine for postoperative analgesia on postoperative depression in patients with gastrointestinal tumors
高洁 1张茜 1戎元元 1胡涛 1高雁 1檀碧波 2付建峰 1刘华琴1
作者信息
- 1. 河北医科大学第四医院麻醉科,石家庄 050011
- 2. 河北医科大学第四医院外三科,石家庄 050011
- 折叠
摘要
目的 评价小剂量艾司氯胺酮术后镇痛对胃肠道肿瘤患者术后抑郁的影响.方法 本研究为前瞻性随机对照研究.选取本院2023年6月至11月择期全身麻醉下行胃肠肿瘤手术患者80例,性别不限,年龄18～64岁,BMI 18～25 kg/m2,ASA分级Ⅱ或Ⅲ级.采用随机数字表法分为2组(n=40):艾司氯胺酮组(E组)和对照组(C组).2组术后均行PCIA,E组PCIA药物配置方案:艾司氯胺酮0.5 mg/kg、地佐辛0.5 mg/kg、右美托咪定1.5 μg/kg和氟比洛芬酯100 mg,用生理盐水稀释至100ml;C组PCIA药物配置方案:地佐辛0.5 mg/kg、右美托咪定1.5μg/kg和氟比洛芬酯100 mg,用生理盐水稀释至100 ml.于术前1 d、术后2 d采用综合医院焦虑抑郁自评量表(HADS)评估焦虑(HADS-A评分)和抑郁(HADS-D评分)情况.采用15项恢复质量量表(QoR-15)评估术后早期恢复质量;记录术后VAS评分、镇痛泵按压次数、补救镇痛次数和药物相关不良反应发生情况.结果 最终纳入78例患者,E组39例,C组39例.与C组比较,E组术后HADS-D评分和抑郁发生率降低,QoR-15评分升高,VAS评分降低(P＜0.05),术后HADS-A评分和焦虑发生率、镇痛泵按压次数,补救镇痛次数差异无统计学意义(P＞0.05).E组1例患者术后1d出现幻视,术后2d即缓解.2组术后头晕、恶心呕吐发生率比较差异无统计学意义(P＞0.05).结论 0.5mg/kg艾司氯胺酮术后镇痛可缓解胃肠肿瘤患者术后抑郁症状,增强镇痛效果,改善术后早期恢复质量.
Abstract
Objective To evaluate the effect of low-dose esketamine for postoperative analgesia on the postoperative depression in patients with gastrointestinal tumors.Methods This study was a prospective randomized controlled trial.Eighty patients,aged 18-64 yr,with a body mass index of 18-25 kg/m2,of American Society of Anesthesiologists Physical Status classification Ⅱ or Ⅲ,scheduled for elective radical resection of the gastrointestinal tumor under general anesthesia from June to November 2023 in our hospital,were divided into 2 groups(n=40 each)using a random number table method:esketamine group(group E)and control group(group C).Each patient received postoperative patient-controlled intravenous analge-sia(PCIA).The PCIA solution in group E contained esketamine 0.5 mg/kg,dezocine 0.5 mg/kg,dexmeto-midine 1.5 μg/kg and flurbiprofen ester 100 mg in 100 ml of normal saline.The PCIA solution in group C contained dezocine 0.5 mg/kg,dexmetomidine 1.5 μg/kg and flurbiprofen ester 100 mg in 100 ml of normal saline.The Hospital Anxiety and Depression Scale(HADS)was used to assess the patients'anxiety and de-pression at 1 day before operation(T0)and 2 days after operation(T1).The Quality of Recovery-15 scale was used to evaluate the early postoperative recovery quality.Visual analog scale scores,the pressing times of patient-controlled analgesia and the number of rescue analgesia were recorded within 2 days after opera-tion.The occurrence of drug-related adverse reactions was also recorded.Results Seventy-eight patients were finally included,with 39 cases in group E and 39 cases in group C.Compared with group C,the post-operative HADS-depression scale score and incidence of depression were significantly decreased,the Quality of Recovery-15 scale score was increased,the visual analog scale scores were decreased(P＜0.05),and no significant changes were found in the postoperative HADS-anxiety scale score and incidence of anxiety,the pressing times of patient-controlled analgesia and the number of rescue analgesia in group E(P＞0.05).Vis-ual hallucination was found at 1 day after operation in one patient and relieved at 2 days after operation in group E.There was no significant difference in the incidence of postoperative dizziness,nausea and vomiting between the two groups(P＞0.05).Conclusions Postoperative analgesia with 0.5 mg/kg esketamine can alleviate postoperative depressive symptoms,enhance the efficacy of analgesia and improve the early postop-erative recovery quality in patients with gastrointestinal tumors.
关键词
氯胺酮/镇痛,病人控制/抑郁/胃肠肿瘤Key words
Ketamine/Analgesia,patient-controlled/Depression/Gastrointestinal neo-plasms引用本文复制引用
基金项目
河北省卫健委重点科技研究计划(20220163)
出版年
2024
NETL
NSTL
万方数据