纳洛酮对氯胺酮辅助麻醉的抑郁症患者复苏及抑郁情绪的影响

Effects of naloxone on resuscitation and depression in patients with depression undergoing ketamineassisted anesthesia

目的探讨纳洛酮对接受氯胺酮辅助麻醉的抑郁症患者的复苏和抑郁情绪的影响。方法选取2017年2月至2019年2月于本院行腹腔镜手术的抑郁症患者86例为研究对象,按随机数字表法分为两组,各43例。所有患者均采用小剂量氯胺酮-瑞芬太尼进行麻醉,其中一组给予纳洛酮用于术后催醒(纳洛酮组),另一组则给予生理盐水(对照组)。比较两组各时间点痛阈值和HAMD-17评分、拔管时间、自主呼吸恢复时间和睁眼时间。结果纳洛酮组术后1h、2h的痛阈值均明显高于对照组(P<0.05);术后,两组HAMD-17评分较术前均有所降低,其中纳洛酮组术后1d和3d的HAMD-17评分均明显高于对照组(P<0.05);纳洛酮组拔管时间、自主呼吸恢复时间和睁眼时间均明显短于对照组(P<0.05)。结论纳洛酮可拮抗瑞芬太尼麻醉所致的痛觉敏化,且有助于患者术后复苏,但会减轻氯胺酮的抗抑郁作用。

Objective To investigate the effects of naloxone on the recovery and depression of patients with depression who received ketamine-assisted anesthesia. Methods 86 depression patients with laparoscopic surgery in our hospital from February 2017 to February 2019 were selected anddivided into two groups according to the random number table method,with 43 cases in each group. All patients were anesthetized with a small dose of ketamine-remifentanil,one group was given naloxone for postoperative wake-up(naloxone group),and the other group was given normal saline(control group). The pain threshold and HAMD-17 score at each time point,extinction time,spontaneous breathing recovery time and blink time of the two groups were compared. Results The pain threshold at 1 h and 2 h after operation of the naloxone group were significantly higher than those of the control group(P<0.05). After operation,the HAMD-17 scores of the two groups were lower than those before the operation,and the HAMD-17 scores of the naltrexone group were significantly higher than those of the control group at 1 and 3 days after operation(P<0.05). The extinction time,spontaneous breathing recovery time and blink time of the naloxone group were significantly shorter than those of the control group(P<0.05). Conclusion Naloxone can antagonize the pain sensitization caused by remifentanil anesthesia and contribute to postoperative resuscitation,but it can significantly reduce the antidepressant effect of ketamine.