亚麻醉剂量艾司氯胺酮复合右美托咪定对妇科手术患者焦虑抑郁情绪及炎症反应的影响

Effect of subanesthetic doses of esketamine combined with dexmedetomidine on the postoperative anxiety-depression and inflammatory response of patients undergoing gynecological general anesthesia

目的探讨亚麻醉剂量艾司氯胺酮复合右美托咪定对妇科全身麻醉手术患者术后焦虑抑郁情绪和炎症反应的影响。方法选择2022年2月至2022年10月于新乡医学院第一附属医院择期行妇科全麻手术患者200例为研究对象。按随机数字表法将患者分为亚麻醉剂量艾司氯胺酮复合右美托咪定组(联合组)、艾司氯胺酮组、右美托咪定组、常规组,每组50例。4组患者术前常规禁食禁水,常规面罩吸氧3 L·min-1。联合组患者麻醉诱导前5 min静脉泵入右美托咪定,以0.3μg·kg^(-1)·h^(-1)的速率维持至术毕前30 min,并于术前5 min单次静脉注射艾司氯胺酮(0.2 mg·kg^(-1));艾司氯胺酮组患者术前5 min单次静脉注射艾司氯胺酮(0.5 mg·kg^(-1)),以0.2 mg·kg^(-1)·h^(-1)的速率维持至术毕前30 min;右美托咪定组患者麻醉诱导前5 min静脉泵入右美托咪定,以0.3μg·kg^(-1)·h^(-1)的速率维持至术毕前30 min;常规组患者麻醉诱导前5 min静脉滴注丙泊酚2.5 mg·kg^(-1),以0.6 mg·kg^(-1)·h^(-1)的速率维持至术毕前30 min。4组患者给予相同的麻醉诱导方法。分别于术前、术后48 h,应用焦虑视觉类比试验(AVAT)评分、医院焦虑抑郁量表(HADS)评分、焦虑自评量表(SAS)评分和抑郁自评量表(SDS)评分评估患者的焦虑、抑郁情况;分别于术前1 d及术后1、3、7 d,采集4组患者外周血2 mL,采用酶联免疫吸附法检测血清中白细胞介素-6(IL-6)、白细胞介素-10(IL-10)和肿瘤坏死因子-α(TNF-α)水平。结果常规组患者术前与术后48 h AVAT、HADS、SAS和SDS评分比较差异无统计学意义(P>0.05);联合组、艾司氯胺酮组和右美托咪定组患者术后48 h AVAT、HADS、SAS和SDS评分均显著低于术前(P<0.05)。术后48 h,联合组、艾司氯胺酮组和右美托咪定组患者AVAT、HADS、SAS和SDS评分显著低于常规组,联合组患者AVAT、HADS、SAS和SDS评分显著低于艾司氯胺酮组和右美托咪定组(P<0.05);艾司氯胺酮组和右美托咪定组患者AVAT、HADS、SAS和SDS评分比较差异无统计学意义(P>0.05)。术后1、3、7 d,4组患者血清IL-6、IL-10、TNF-α水平均显著高于术前1 d(P<0.05);4组患者术后3、7 d血清IL-6、IL-10水平显著低于术后1 d,TNF-α水平显著高于术后1 d(P<0.05);4组患者术后7 d血清IL-6、IL-10水平显著低于术后3 d,TNF-α水平显著高于术后3 d(P<0.05)。术前1 d,4组患者血清IL-6、IL-10、TNF-α水平比较差异无统计学意义(P>0.05)。术后1、3、7 d,联合组、艾司氯胺酮组和右美托咪定组患者血清IL-6、IL-10、TNF-α水平显著低于常规组(P<0.05);联合组和艾司氯胺酮组患者血清IL-6、IL-10、TNF-α水平显著低于右美托咪定组(P<0.05);联合组患者血清IL-6、IL-10、TNF-α水平显著低于艾司氯胺酮组(P<0.05)。结论亚麻醉剂量艾司氯胺酮与右美托咪定联合应用可显著改善妇科全身麻醉手术患者的焦虑抑郁情绪和炎症反应。

Objective To investigate the effect of subanesthetic doses of esketamine combined with dexmedetomidine on the postoperative anxiety-depression and inflammatory response of patients undergoing gynecological general anesthesia.Methods Two hundred patients who underwent elective gynecological surgery under general anesthesia in the First Affiliated Hospital of Xinxiang Medical University from February 2022 to October 2022 were selected as the research subjects.According to random number table method,the patients were divided into the subanesthetic dose of esketamine combined with dexmedetomidine group(combination group),esketamine group,dexmedetomidine group,and conventional group,with 50 cases in each group.The patients in the four groups were routinely fasted for solids and liquids before the operation and inhaled oxygen at a rate of 3 L·min-1 through the face mask.Patients in the combination group received dexmedetomidine intravenously 5 minutes before the anesthesia induction,and the dexmedetomidine injection was maintained at a rate of 0.3μg·kg^(-1)·h^(-1) until 30 minutes before the end of operation;additionally,a single intravenous injection of esketamine(0.2 mg·kg^(-1))was administered 5 minutes before operation.Patients in the esketamine group received a single intravenous injection of esketamine(0.5 mg·kg^(-1))5 minutes before operation,at a rate of 0.2 mg·kg^(-1)·h^(-1) until 30 minutes before operation.Patients in the dexmedetomidine group received intravenous infusion of dexmedetomidine 5 minutes before anesthesia induction,at a rate of 0.3μg·kg^(-1)·h^(-1) until 30 minutes before operation.Patients in the conventional group received intravenous infusion of propofol(2.5 mg·kg^(-1))5 minutes before anesthesia induction,at a rate of 0.6 mg·kg^(-1)·h^(-1) until 30 minutes before operation.The patients in the four groups were given the same anesthesia induction.Before and 48 hours after operation,the anxiety and depression levels of patients in the four groups were evaluated using the Anxiety Visual Analogy Test(AVAT)score,Hospital Anxiety and Depression Scale(HADS)score,Self-rating Anxiety Scale(SAS)score,and Self-rating Depression Scale(SDS)score.One day before operation,1,3 and7 days after operation,2 mL peripheral blood was collected from patients in the four groups,and the serum interleukin-6(IL-6),interleukin-10(IL-10),and tumor necrosis factor-α(TNF-α)levels were detected by the enzyme-linked immunosorbent assay.Results There was no significant difference in AVAT,HADS,SAS and SDS scores of patients before operation and 48 hours after operation in the conventional group(P>0.05),while the AVAT,HADS,SAS and SDS scores 48 hours after operation in the combination group,esketamine group and dexmedetomidine group were significantly lower than those before operation(P<0.05).Forty-eight hours after operation,the AVAT,HADS,SAS and SDS scores of patients in the combination group,esketamine group and dexmedetomidine group were significantly lower than those in the conventional group;the AVAT,HADS,SAS and SDS scores of patients in the combination group were significantly lower than those in the esketamine and dexmedetomidine groups(P<0.05);and there was no statistically significant difference in AVAT,HADS,SAS,and SDS scores between the esketamine group and the dexmedetomidine group(P>0.05).1,3 and 7 days after operation,the serum IL-6,IL-10,and TNF-αlevels of patients in the four groups were significantly higher than those 1 day before surgery(P<0.05).The serum IL-6 and IL-10 levels 3 and 7 days after operation in the four groups were significantly lower than those 1 day after operation,while the serum TNF-αlevel was significantly higher than that 1 day after operation(P<0.05).The serum IL-6 and IL-10 levels 7 days after operation in the four groups were significantly lower than those 3 days after operation(P<0.05).There was no statistically significant difference in serum IL-6,IL-10,and TNF-αlevels of patients among the four groups 1 day before surgery(P>0.05).1,3 and 7 days after operation,the serum IL-6,IL-10,and TNF-αlevels of patients in the combination group,esketamine group,and dexmedetomidine group were significantly lower than those in the conventional group(P<0.05);the serum IL-6,IL-10,and TNF-αlevels of patients in the combination group and esketamine group were significantly lower than those in the dexmedetomidine group(P<0.05);and the serum IL-6,IL-10,and TNF-αlevels of patients in the combination group were significantly lower than those in the esketamine group(P<0.05).Conclusion A subanesthetic dose of esketamine combined with dexmedetomidine can significantly relieve postoperative anxiety-depression and inflammatory response of patients undergoing gynecological general anesthesia.