右美托咪定联合右旋氯胺酮静脉患者自控镇痛对癌痛患者抑郁情绪的影响

Effect of intravenous patient-controlled analgesia with dexmetaminidine and esketamine on depression in patients with cancer pain

目的观察右美托咪定联合右旋氯胺酮静脉患者自控镇痛(PCA)对癌痛患者抑郁情绪的影响。方法 60例实施镇痛的癌痛患者随机分为两组,每组30例。C组静脉PCA吗啡剂量为口服剂量的1/3,DK组加用右美托咪定0.1μg·kg^(-1)·h^(-1)联合右旋氯胺酮60μg·kg^(-1)·h^(-1)静脉PCA。记录用药前(T0)和PCA 6 h(T1)、12 h(T2)、24 h(T3)和48 h(T4)时的数字评价量表(NRS)镇痛评分、Ramsay镇静评分、状态-特质焦虑问卷评分及贝克抑郁量表第二版(BDI-Ⅱ)评分。观察48 h内的镇痛、镇静效果和抑郁等不良反应发生情况。结果与T0比较,两组T1~T4时的NRS镇痛评分、BDI-Ⅱ评分和状态焦虑评分降低,Ramsay镇静评分、患者生活质量和满意度评分升高(P<0.05)。与C组比较,DK组T1~T4时的NRS镇痛评分、BDI-Ⅱ评分和状态焦虑评分降低,患者生活质量和满意度评分升高(P<0.05)。与C组相比,DK组患者抑郁发生率降低,镇痛有效率升高,恶心和呕吐发生率降低(P<0.05)。结论右美托咪定联合右旋氯胺酮静脉PCA能显著增强癌痛患者的镇痛效果,改善癌痛患者的焦虑、抑郁情绪,提高患者生活质量。

Objective To observe the effect of intravenous patient-controlled analgesia(PCA) with dexmetaminidine and esketamine on depression in the patients with cancer pain.Methods Sixty patients with cancer pain undergoing analgesia were randomized into two groups with 30 cases each.The patients in group C accepted morphine in a one third dose of usual dose.The patients in group DK were given additional intravenous PCA with esketamine 60 μg·kg^(-1)·h^(-1) and dexmedetomidine 0.1 μg·kg^(-1)·h^(-1).The numeric rating scales(NRS) score, Ramsay sedation score, status-trait anxiety score and Beck depression inventory Ⅱ(BDI-Ⅱ) score were recorded at the time points of before(T0) and the 6th(T1),12th(T2),24th(T3),and 48th(T4) hours during analgesia.The analgesia and sedation effectiveness, depression and incidence of adverse responses within 48 hours were observed.ResultsCompared with T0,the scores of NRS,BDI-Ⅱ and status anxiety were decreased, while the scores of Ramsay sedation, life quality and satisfaction were increased at T1-T4 in both groups(P<0.05).Compared with group C,the scores of NRS,BDI-Ⅱ and status anxiety were decreased, while the life quality score and satisfaction score were increased at T1-T4 in group DK(P<0.05).Compared with group C,the effective rate of analgesia was increased, while the incidences of depression, nausea and vomiting were significantly decreased in group DK(P<0.05).Conclusion Intravenous PCA with dexmedetomidine and esketamine in the patients with cancer pain can remarkably enhance the analgesia effectiveness, improve the anxiety and depression, life quality and satisfaction.