单次亚麻醉剂量氯胺酮对乳腺癌根治患者术后早期情绪及恢复质量的影响

Effect of a single sub-anesthetic dose of ketamine on emotionand quality of recovery of patients withradical mastectomy during early period of postoperative

目的观察单次亚麻醉剂量氯胺酮对乳腺癌根治患者术后早期抑郁和焦虑情绪反应和术后早期恢复质量的影响。方法 80例择期拟行乳腺癌根治患者,采取随机数字表分为氯胺酮组(Ket组)和对照组(Con组),每组40例。常规静脉麻醉诱导并置入喉罩机械通气后,Ket组和Con组分别静脉持续泵注50 mL氯胺酮(0.5 mg/kg)和0.9%氯化钠注射溶液,均持续20 min泵完。术后所有患者采用相同的镇痛方案。采用抑郁自评量表(SDS量表)和焦虑自评量表(SAS量表)于术前1天以及术后第3天对患者情绪进行评估,同时采用40项恢复质量评分量表(QoR-40量表)对患者术后恢复质量进行评估。术后2 d内观察并记录患者的NRS疼痛评分,当NRS评分≥4分时给予补救镇痛,每次静脉给予2 mg羟考酮,并记录为1次补救镇痛。记录术后气管导管拔除时间、拔管时有无呛咳、苏醒期有无躁动及谵妄的记录在恢复室(PACU)期间的Ramsay镇静评分,幻觉、恶心、复视、呕吐、头晕等不良反应。结果与Con组比较,Ket组术后第3天的SDS量表和SAS量表的评分均降低(P<0.05),术后抑郁的发生率(Con组比Ket组:37.5%比55%)和焦虑的发生率(Con组比Ket组:45%比57.5%)也有较明显降低;与Con组比较,Ket组术后第3天的QoR-40量表评分升高(P<0.05);与Con组比较,Ket组术后2天内补救镇痛比例有较明显降低;两组在恢复室期间的Ramsay镇静评分差异无统计学意义。术后两组患者喉罩拔除时间、复苏室内谵妄及躁动的发生率差异均无统计学意义。复苏室观察期间,两组均未出现明显复视、恶心、头晕、呕吐等不良反应。结论乳腺癌根治患者静脉给予单次亚麻醉剂量氯胺酮能降低术后早期抑郁评分及焦虑评分,提高术后早期恢复质量。

Objective To evaluate the effects of a single sub-anesthetic dose of ketamine on emotionand quality of recovery of patients with radical mastectomy during early period of postoperative.Methods Eighty patients(physical status ASA Ⅰ/Ⅱ,aged 18-60 years,body mass index(BMI) 18-30 kg/m^2) scheduled for radical mastectomy were randomly divided into either ketamine group(n=40) or control group(n=40) using a random number table.After the routine induction of general anesthesia,ketamine 0.5 mg/kg were infused with micro-pump to patients in Ket group while the same volume ofnormal saline were infused to patients in Control group,,both were finished within 20 minutes.The intravenous analgesia program was identical between the two groups.The Self-rating Depression Scale and Self-rating Anxiety Scale was used to assess the emotional reactions of patients and the global QoR-40 aggregate score was used to assess the quality of patients recovery at Preoperative 1 day and 3 day after surgery respectively.The numeric rating scale(NRS) pain score in the first 2 d postoperative period was observed,when NRS scores ≥4,oxycodone 2 mg was used as rescue analgesic,the requirement for rescue analgesics was recorded.The time of extubation,restlessness and delirium were recorded,and the Ramsay sedation score,dizziness,nausea,vomiting,diplopia and hallucinations in the postoperative recovery room(PACU) were recorded.Results Compared with control group,The SDS scale and SAS scale scores were lower on the 3 rd day after surgery in Ket group(P<0.05),the incidence of postoperative depression(Con vs Ket: 37.5% vs 55%) and anxiety(Con vs Ket: 45% vs 57.5%) also decreased significantly in Ket group.Compared with Control group,the global QoR-40 scores were higher in Ket group 3 rd day after surgery(P<0.05).Compared with Control group,the incidence of remedial analgesia within 2 days after surgery was lower in Ket group.There was no statistically significant difference in Ramsay sedation scores,extubation time,restlessness and delirium after extubation between the two groups.No obvious diplopia,nausea,dizziness,vomiting or other adverse reactions were observed during PACU.Conclusion A single sub-anesthetic dose of ketamine can reduce the scores of postoperative depression and anxiety,decrease the incidence of depression and anxiety and improve the quality of recovery during the early period after radical mastectomy.