艾司氯胺酮对子宫切除术患者术后焦虑抑郁的影响

Effects of Esketamine on Postoperative Anxiety and Depression in Patients Undergoing Hysterectomy

目的:观察艾司氯胺酮对子宫切除术后患者焦虑抑郁的影响。方法:选择全身麻醉下行腹腔镜子宫切除手术的患者160例。采用数字表法随机分为艾司氯胺酮组(E组)和对照组(C组),每组80例。E组在手术切皮前5 min给予单剂量艾司氯胺酮0.4 mg·kg^(-1)(生理盐水稀释10 mg·mL^(-1)),C组在同样的时间输注等量的生理盐水。采用蒙哥马利-阿斯伯格抑郁量表(MADRS)、广泛性焦虑量表(GAD-7)对患者术前1天、术后第1天和第7天情绪进行评价。记录入室后5 min、插管即刻、切皮和拔管时的血压、心率,术中麻醉药物用量,术毕即刻、术后2 h和24 h视觉模拟评分(VAS)、舒适评分(BCS)及术后不良反应和住院时间。结果:和C组相比,E组术后24 h MARDS评分明显降低(P<0.05)。E组术后24 h MARDS评分>11的人数显著少于C组(P<0.05)。两组术后24 h和7 d的GAD-7评分差异无统计学意义(P>0.05)。E组术中瑞芬太尼用量低于C组,差异具有统计学意义。术后2 h的VAS评分E组低于C组,差异具有统计学意义(P<0.05)。术后不良反应比较,两组差异无统计学意义(P>0.05)。结论:术前亚麻醉剂量的艾司氯胺酮可降低术后第1天抑郁发生率和严重程度,且在患者术后2 h具有良好的镇痛效果,术后不良反应也未见显著升高,值得临床推广。

Objective:To observe the effects of esketamine on anxiety and depression in patients after hysterectomy.Method:A total of 160 patients for laparoscopic hysterectomy under general anesthesia were randomly divided into group E and C by a digital table method,with 80 in each group.Patients in group E were given a single dose of esketamine(0.4 mg·kg^(-1),diluted with normal saline to 10 mg·mL^(-1))5 min before surgical incision,and patients in group C were given the same dose of normal saline at the same time.The Montomery-Ashberg Depression Rating Scale(MARDS)and Generalized Anxiety Disorder7-item scale(GAD-7)were used to evaluate the mood of patients 1 day before surgery and 1 day and 7 days after surgery.The blood pressures and heart rates were recorded 5 minutes after entry,immediately after intubation,during skin incision and extubation.Data of intraoperative anesthetic dosage,visual analogue scale(VAS)and Bruggrmann comfort scale(BCS)immediately,2 h and 24 h postoperative,postoperative adverse reactions and length of stay were recorded.Results:Compared with group C,MARDS scores of group E significantly decreased at 24 h after surgery(P<0.05).The number of patients with postoperative MARDS>11 in group E was significantly less than that in group C(P<0.05).There were no significant differences in GAD-7 scores at 1 d and 7 d after surgery between the two groups(P>0.05).The intraoperative dosage of remifentanil in group E was significantly lower than that in group C(P<0.05).The VAS score of group E was significantly lower than that of group C at 2 h after surgery(P<0.05).There was no significant difference in postoperative adverse reactions between the two groups(P>0.05).Conclusion:Esketamine at a subanesthetic dose before surgery can reduce the incidence and severity of depression on the first day after surgery,has a good analgesic effect in patients two hours after surgery and does not significantly increase postoperative adverse reactions,which is worthy of clinical promotion.