小剂量艾司氯胺酮复合全身麻醉对腹腔镜全子宫切除术后抑郁的影响

Effects of Low Dose Esketamine Combined with General Anesthesia on Depression After Laparoscopic Total Hysterectomy

目的探讨小剂量艾司氯胺酮复合全身麻醉改善腹腔镜全子宫切除术患者术后焦虑抑郁情绪的效果。方法选择锦州医科大学附属第一医院妇科2020年12月至2021年10月择期行腹腔镜全子宫切除术患者180例,年龄35~65岁,ASA分级I~II级,将患者随机分为ES组(n=90)和C组(n=90)。ES组在切皮前静脉注射艾司氯胺酮0.25 mg/kg,随后以0.125 mg/(kg·h)持续泵注直至手术结束,C组静脉注射等量生理盐水。于术前1 d、术后1 d、术后3 d、术后1 w和术后1个月行焦虑自评量表(SAS)和抑郁自评量表(SDS)评估焦虑、抑郁情况;记录术后3 d内镇痛药使用情况;记录术后24 h内恶心呕吐、幻觉噩梦、嗜睡、头晕头痛等不良反应情况。结果在术后1 d和术后3 d时,ES组焦虑抑郁的比例明显低于C组,SAS评分和SDS评分明显低于C组(P<0.05),术后1 w和术后1个月的SAS评分和SDS评分无明显差异;ES组停药-拔管时间高于C组(P<0.05);ES组术后首次使用镇痛药的时间长于C组,术后阿片类药物用量明显低于C组(P<0.05);ES组恶心呕吐的发生率低于C组(P<0.05)。结论小剂量艾司氯胺酮复合全身麻醉能够改善术后早期的焦虑抑郁情绪,缓解术后疼痛,减少术后阿片类药物用量,延长镇痛时间并且不增加术后不良反应的发生率。

Objective To investigate the effect of low dose esketamine combined with general anesthesia on postoperative anxiety and depression in patients with laparoscopic total hysterectomy.Methods 180 patients,aged 35-65 years and with ASA grade I-II,who underwent laparoscopic total hysterectomy from December 2020 to October 2021 were randomly divided into ES group(n=90)and C group(n=90).In ES group,esketamine 0.25 mg/kg was injected intravenously before skin incision,and then pumped continuously with 0.125 mg/(kg·h)until the end of the operation.In C group,the same amount of normal saline was injected intravenously.Self-Rating Anxiety Scale(SAS)and Self-Rating Depression Scale(SDS)were used to evaluate anxiety and depression 1 d before operation,1 d after operation,3 d after operation,1 w after operation and 1 month after operation;the use of analgesics within 3 d after operation was recorded;adverse reactions such as nausea and vomiting,hallucinations and nightmares,drowsiness,dizziness and headache were recorded within 24 hours after operation.Results At 1 d and 3 d after operation,the proportion of anxiety and depression in ES group was significantly lower than that in C group,and the SAS score and SDS score were significantly lower than those in C group(P<0.05).There was no significant difference in SAS score and SDS score at 1 w and 1 month after operation;the time of drug withdrawal and extubation in ES group was higher than that in C group(P<0.05);the first use of analgesics in ES group was longer than that in C group,and the dosage of opioids was significantly lower than that in C group(P<0.05);the incidence of nausea and vomiting in ES group was lower than that in C group(P<0.05).Conclusion Low dose esmketamine combined with general anesthesia can improve early postoperative anxiety and depression,relieve postoperative pain,reduce the dosage of postoperative opioids,prolong the analgesic time,and does not increase the incidence of postoperative adverse reactions.