艾司氯胺酮对腹腔镜手术病人疼痛介质与术后早期抑郁的影响

Effects of esketamine on pain mediators and early postoperative depression in patients undergoing laparoscopic surgery

目的:探讨艾司氯胺酮对腹腔镜手术病人疼痛介质与术后早期抑郁的影响。方法:选取拟行全身麻醉(全麻)下腹腔镜手术病人60例,随机分为S组和C组,各30例。S组病人在全麻诱导后静脉缓慢注射艾司氯胺酮0.2 mg/kg,随后以0.1 mg·kg^(-1)·h^(-1)速度泵注,直至术毕前20 min停药;C组以同样方法给予等量0.9%氯化钠溶液。记录并比较2组病人术后恶心呕吐和呼吸抑制发生情况,麻醉苏醒即刻(T_(1))、术后6 h(T_(2))、术后24 h(T_(3))视觉模拟评分(VAS),麻醉前(T_(0))、T_(1)、T_(2)、T_(3)时血清前列腺素E2(PGE2)、P物质(SP)和β-内啡肽(β-EP)水平,T_(0)及术后72 h(T_(4))健康问卷抑郁量表(PHQ-9)评分。结果:2组病人术后恶心呕吐和呼吸抑制发生率差异均无统计学意义(P>0.05)。S组病人T_(1)、T_(2)时VAS评分均低于C组(P<0.01和P<0.05)。2组病人T_(0)时PEG2、SP和β-EP差异均无统计学意义(P>0.05);T_(1)~T_(3)时S组PEG2、SP水平均低于C组(P<0.05~P<0.01);T_(1)、T_(2)时S组β-EP水平亦均低于C组(P<0.05)。2组病人T_(0)时PHQ-9评分差异无统计学意义(P>0.05),S组T_(4)时病人PHQ-9评分低于C组(P<0.05)。结论:全麻下腹腔镜手术中使用艾司氯胺酮可提供良好术后镇痛,抑制疼痛介质分泌,改善病人术后早期抑郁情绪,且不增加术后不良反应。

Objective:To study the effects of esketamine on pain mediators and early postoperative depression in patients undergoing laparoscopic surgery.Methods:A total of 60 patients who underwent laparoscopic surgery were selected and randomly divided into esketamine group(group S,n=30)and control group(group C,n=30).In group S,patients were received 0.2 mg/kg esketamine intravenously after anesthesia induction followed by infusing continuously at a dose of 0.1 mg·kg^(-1)·h^(-1)until 20 minutes before the end of surgery.In group C,patients were given the same amount of 0.9%sodium chloride solution in the same way.The incidence of postoperative nausea,vomiting and respiratory depression,visual analogue score(VAS)at the time of recovery(T_(1)),6 h after surgery(T_(2))and 24 h after surgery(T_(3)),prostaglandin E2(PGE2),substance P(SP)andβ-endorphin(β-EP)level at the time of pre-anesthesia(T_(0)),recovery(T_(1)),6 h after surgery(T_(2))and 24 h after surgery(T_(3)),and PHQ-9 score at time of pre-anesthesia(T_(0)),recovery(T_(1))and 72 h after surgery(T_(4))were recorded.Results:There was no significant difference in the incidence of postoperative adverse reactions between two groups(P>0.05).The VAS scores at T_(1)and T_(2)in group S were lower than those in group C(P<0.01 and P<0.05).There was no difference in the levels of PEG2,SP andβ-EP at T_(0)between two groups(P>0.05).The levels of PEG2 and SP at T_(1)-T_(3)and the levels ofβ-EP at T_(1)and T_(2)in group S were lower than those in group C(P<0.05 to P<0.01).There was no difference in PHQ-9 score at T_(0)between two groups(P>0.05).Compared to group C,PHQ-9 score at T_(4)in group S were lower(P<0.05).Conclusions:Using esketamine in general anesthesia undergoing laparoscopic surgery can provide well postoperative analgesia,inhibit the secretion of pain mediators,improve early postoperative depression of patients,and do not increase the incidence of postoperative adverse reactions.