乳腺癌患者术前抑郁状态对地佐辛静脉镇痛效果和血清5羟色胺浓度的影响的初步研究

The preliminary study on the effects of preoperative depression condition in patients with breast cancer on the efficacy of intravenous analgesia with dezocine and the serum level of 5 hydroxytryptamine

目的初步探讨乳腺癌患者术前抑郁状态对地佐辛静脉镇痛效果和血清5羟色胺水平的影响。方法对60例乳腺癌患者术前采用24项版汉密尔顿抑郁量表（HAMD）评定其抑郁症状评分，按照评分结果分为抑郁组（12例）、可疑组（22例）、正常组（26例）。术后均采用地佐辛静脉镇痛，于术后2、12和24h采用视觉模拟评分法（VAS）评估术后镇痛效果，并于麻醉前、手术开始后2h和术后24h抽取静脉血采用酶联免疫法测定血清5羟色胺浓度。结果术后12h和24h可疑组和抑郁组VAS评分均高于正常组（P〈0．05），可疑组与抑郁组比较差异无统计学意义（P〉0．05）；三组血清5羟色胺浓度手术开始后2h明显增高（P〈0．05），术后24h明显下降；组间比较，抑郁组和可疑组的血清5羟色胺浓度在三个时点均低于正常组（P〈0．05），抑郁组的血清5羟色胺浓度在三个时点均低于可疑组（P〈0．05）。结论在本研究的条件下，乳腺癌患者术前抑郁症状可能影响地佐辛静脉镇痛的效果，并可能与血清5羟色胺水平有关。

Objective To explore preliminarily the effects of preoperative depression condition in patients with breast cancer on the efficacy of intravenous analgesia with dezocine and the serum level of 5 hydroxytryptamine. Methods Sixty patients with breast cancer were assessed with Hamilton depression scale （HAMD）. The total patients were divided into three groups according to HAMD scores, including normal group （26 cases） , suspicious group （22 cases）, and depression group （12 cases） . The postoperative analgesia was facilitated with patients intravenous control analgesia with dezocine and the postoperative pain was assessed by visual analogue scale （VAS） at 2 hours, 12 hours, and 24 hours. Yhe serum concen- tration of 5 hydroxytryptamine was measured by enzyme-linked immunosorbent assays before anesthesia, 2 hours after surgery beginning, and 24 hours after surgery. Results The postoperative VAS at 12 hours and 24 hours in suspicious group and in depression group were higher than those in normal group （ P 〈 0.05 ）. There was no statistical difference between depression and suspicious groups （ P 〉 0. 05 ）. The serum concentrations of 5 hydroxytryptamine in three groups increased obviously at 2 hours after surgery beginning （P〈0.05）, and then decreased at 24 hours postoperation. The serum concentrations of 5 hydroxytryptamine in suspicious group and depression group at three measurement point were significantly lower than those in normal group （ P 〈 0. 05 ）. The serum concentrations of 5 hydroxytryptamine in depression group at three measurement point were significantly lower than those in suspicious group （ P 〈0. 05 ）. Conclusions Under this preliminary study condition, the preoperative severity of the depression in patients with breast cancer may affect the analgesia effect of patients intravenous control analgesia with dezocine and maybe have some relationships with serum levels of 5 hydroxytryptamine.