艾司氯胺酮对腹腔镜子宫颈环扎术患者术后抑郁和焦虑的影响

Effects of esketamine on postoperative depression and anxiety in patients undergoing laparoscopic cervical cerclage

目的:探讨艾司氯胺酮对腹腔镜子宫颈环扎术患者术后抑郁和焦虑的影响。方法:选取2022年8月—2023年2月在揭阳市人民医院择期行腹腔镜子宫颈环扎术的76例患者,年龄20~45岁,美国麻醉医师协会分级Ⅰ~Ⅱ级,体重指数18.5~28.0 kg/m2,随机分为艾司氯胺酮组和对照组,每组38例。全麻诱导插管后,艾司氯胺酮组静脉注射0.4 mg/kg艾司氯胺酮,对照组静脉注射等容量生理盐水。记录患者术前1 d、术后3、14、28 d的抑郁自评量表评分与焦虑自评量表评分。记录患者术后2、6、12、24 h的视觉模拟评分法痛觉评分和补救镇痛情况。记录患者睁眼时间、自主呼吸恢复时间、拔管时间及术后不良反应发生情况。结果:最终纳入73例患者,艾司氯胺酮组37例,对照组36例。与对照组相比,艾司氯胺酮组患者术后3、14 d的抑郁自评量表、焦虑自评量表评分降低,术后2、6 h的视觉模拟评分法痛觉评分降低,补救镇痛例数降低,差异有统计学意义(均P<0.05)。两组患者术后睁眼时间、自主呼吸恢复时间、拔管时间及术后不良反应发生率差异无统计学意义(均P>0.05)。结论:围术期使用艾司氯胺酮可缓解腹腔镜子宫颈环扎术患者术后抑郁和焦虑,并减轻患者的术后疼痛。

Objective:To investigate the effects of esketamine on postoperative depression and anxiety in patients undergoing laparoscopic cervical cerclage.Methods:Seventy-six patients,aged 20-45 years,American Society of Anesthesiologists classification I-II,body mass index 18.5-28.0 kg/m2,who underwent elective laparoscopic cervical cerclage in Jieyang People’s Hospital from August 2022 to February 2023 were selected and randomly divided into the esketamine group and the control group,with 38 cases in each group.After general anesthesia induction and intubation,0.4 mg/kg of esketamine was injected intravenously in the esketamine group,and an equal volume of saline was injected intravenously in the control group.The patients’self-rating depression scale(SDS)scores and self-rating anxiety scale(SAS)scores were recorded at 1 d preoperatively,3,14 and 28 d postoperatively.The patients’visual analogue scale(VAS)pain scores at 2,6,12,and 24 h postoperatively and remedial analgesia were recorded.The patients’eye opening time,spontaneous respiration recovery time,extubation time and the occurrence of postoperative adverse reactions were recorded.Results:Seventy-three patients were finally included,37 in the esketamine group and 36 in the control group.Compared with the control group,patients in the esketamine group had lower SDS and SAS scores at 3 and 14 d postoperatively,lower VAS scores at 2 and 6 h postoperatively,and lower cases of remedial analgesia,and the differences were statistically significant(all P<0.05).There was no statistically significant difference in the postoperative eye-opening time,spontaneous respiration recovery time,extubation time and incidence of postoperative adverse reactions between the two groups(all P>0.05).Conclusion:Perioperative use of esketamine relieves postoperative depression and anxiety and reduces postoperative pain in patients undergoing laparoscopic cervical cerclage.