艾司氯胺酮术后镇痛对宫颈癌术后免疫功能及早期焦虑抑郁状态的影响

Effects of esketamine for postoperative analgesia on postoperative immune function and early-stage anxiety and depression in patients with cervical cancer

目的探讨艾司氯胺酮对腹腔镜宫颈癌根治术患者的术后镇痛效果,免疫功能及术后早期焦虑抑郁状态的影响。方法选取2021年12月至2022年10月拟择期行腹腔镜宫颈癌根治术患者60例,采用随机数字表法分为2组。观察组术后镇痛采用舒芬太尼1μg/kg+艾司氯胺酮1 mg/kg,对照组采用舒芬太尼2μg/kg患者自控镇痛。比较2组患者术后4 h(T_(1))、12 h(T_(2))、24 h(T_(3))及48 h(T_(4))疼痛程度NRS评分和不良反应;ELISA法测定麻醉前30 min、术后24 h及48 h血清IFN-γ、IL-4及IFN-γ/IL-4,比较2组患者于术前1 d,术后第3 d焦虑自评量表(SAS)和患者抑郁自评量表(SDS)。结果2组患者术后各时间点NRS评分差异无统计学意义(P>0.05),观察组术后PONV发生率低于对照组(P<0.05);与T0相比,观察组术后24 h血清IFN-γ水平与IFN-γ/IL-4比值下降,而血清IL-4水平升高(P<0.05);而且术后48 h血清血清IFN-γ水平与IFN-γ/IL-4比值与基线水平相似(P>0.05)。与对照组相比,观察组在术后24 h和48 h血清IFN-γ水平与IFN-γ/IL-4比值增高,而术后24 h时IL-4水平降低(P<0.05)。术后第3天观察组患者SAS评分和SDS评分均高与术前第1天(P<0.05);而对照组术后第3天仅SAS评分高于术前(P<0.05);术后第3天观察组的SAS评分和SDS评分均低于对照组(P<0.05)。结论艾司氯胺酮用于宫颈癌患者术后静脉自控镇痛,可以有效的缓解术后疼痛,调节炎性因子释放,从而改善术后免疫功能,并且有效改善术后早期焦虑抑郁状态。

Objective To investigate the effects of esketamine on postoperative analgesia,immune function and early-stage postoperative anxiety and depression in patients undergoing laparoscopic radical cervical cancer surgery.Methods Sixty patients treated with elective laparoscopic radical cervical cancer surgery from December 2021 to October 2022 were included.They were randomly divided into the observation group and control group by computeRrandom number table.Patients in the observation group were given intravenous 1mg/kg esketamine combined with 1μg/kg sufentanil for postoperative controlled analgesia,and those in the control group were given 2μg/kg sufentanil for postoperative controlled analgesia.The pain degree assessed by the Numerical Rating Scale(NRS)at 4h(T_(1)),12h(T_(2)),24h(T_(3))and 48h(T_(4))postoperatively,and the adverse events were compared between the two groups.Serum levels of interferon-gamma(IFN-γ),interleukin-4(IL-4)and the IFN-γ/IL-4 ratio were measured at 30min before induction,T_(3) and T_(4) by ELISA.The Self-Rating Anxiety Scale(SAS)and the Self-Rating Depression Scale(SDS)scores at 1d preoperatively and 3 d postoperatively were compared between groups.Results There was no significant difference in the NRS score at each time point between groups(P>0.05).The incidence of postoperative nausea and vomiting(PONV)in the observation group was significantly lower than that of the control group(P<0.05).Compared with those at T0,serum levels of IFN-γand IFN-γ/IL-4 ratio significantly decreased at T_(3),and IL-4 significantly increased in the observation group(P<0.05).Moreover,serum IFN-γlevel and IFN-γ/IL-4 ratio at T_(4) in the observation group were similaRto the baseline levels(P>0.05).Serum levels of IFN-γand the IFN-γ/IL-4 ratio at T_(3) and T_(4) in the observation group were significantly higher compared with those of the control group,while serum IL-4 at T_(3) was significantly lower (P<0.05).The SAS and SDS scores at 3d postoperatively in the observation group were significantly higher than those at 1d preoperatively(P<0.05).In the control group,only the SAS score at 3 d postoperatively was significantly higher than that at 1 d preoperatively(P<0.05).The SAS and SDS scores of the observation group at 3 d postoperatively were significantly lower than those of the control group(P<0.05).Conclusion Esketamine can effectively relieve postoperative pain,regulate the release of inflammatory factors,improve postoperative immune function and effectively alleviate early-stage postoperative anxiety and depression of patients with cervical cancer.