小剂量氯胺酮对食道癌根治术患者单肺通气期间炎症介质及术后抑郁样情绪的影响

The effect of ketamine on the postoperative depression-like mood and inflammatory mediators during one lung ventilation in patients with esophageal cancer radical surgery

目的观察小剂量氯胺酮对食道癌根治术患者单肺通气期间炎症介质及术后抑郁样情绪的影响。方法将60例择期食道癌手术患者随机分成氯胺酮组(K组)和对照组(C组)。分别于麻醉诱导后给予氯胺酮和生理盐水0.5 mg/kg,然后0.25 mg/(kg·h)泵注30 min。观察不同时间点TNF-α、IL-6、IL-10浓度及PHQ-9评分。结果 K组术后5 d PHQ-9评分明显低于术前(P<0.05);与C组比较,K组术后5 d PHQ-9评分明显降低(P<0.05)。两组患者血清TNF-α、IL-6和IL-10浓度T_1之后均明显上升(P<0.05);与C组比较,K组T_2、T_3时相TNF-α、IL-6、IL-10浓度无统计学差异(P>0.05)。结论小剂量氯胺酮能明显改善食道癌根治术患者术后抑郁样情绪,对单肺通气期间炎症介质TNF-α、IL-6、IL-10浓度影响不明显。

Objective To observe the effect of ketamine at low dose on inflammatory mediators during one lung ventilation and postoperative depression-like mood in patients with esophageal cancer radical surgery. Methods 60 patients who underwent esophageal cancer radical surgery were randomly divided into ketamine group （K） and control group（C）. The patients in group K was injected with ketamine at a dose of 0.5 mg/kg at the time of anesthesia induction, then continuous infused with ketamine at a dose of 0.25 mg/（kg·h） for 30 minutes. Patients in group C： saline was given .Then concentrations of TNF-α, IL-6, IL-10 and PHQ-9 scores at different time points were evaluated. Results The PHQ-9 scores of the patients in K group at the 5 d after operation was significantly lower than that at the ld before operation （P 〈 0.05 ） ;The PHQ-9 scores in group K were decreased ob- viously than that those in group C （P 〈 0.05 ）. The concentration of serum TNF-a, IL-6 and IL-10 were significantly increased after T1 time of the two groups （P 〈 0.05 ） ; Compared with group C, there was no statistical difference in the levels of TNF-α, IL-6 and IL-10 in group K at T2 and T3 time （P 〈 0.05 ）.Conclusion Low dose ketamine has no obvious effect on the concentration of blood TNF-α, IL-6 and IL -10 during one lung ventilation in patients with esophageal cancer radical surgery, but it may alleviate postoperative depression-like mood.