艾司氯胺酮对老年肺癌患者胸腔镜肺叶切除术后焦虑、抑郁及认知功能的影响

Effects of esketamine on anxiety,depression and cognitive function in elderly patients with lung cancer after thoracoscopic lobectomy

目的评估艾司氯胺酮对老年肺癌患者胸腔镜肺叶切除术后焦虑、抑郁及认知功能的影响。方法80例择期行胸腔镜肺叶切除术的老年肺癌患者,随机分为试验组和对照组,各40例。两组均行全身麻醉,试验组麻醉诱导时静脉注射0.2 mg/kg艾司氯胺酮,对照组给予等量生理盐水。术后均实施静脉自控镇痛(PCIA),试验组给予舒芬太尼1.2μg/kg、艾司氯胺酮0.3 mg/kg、托烷司琼10 mg;对照组给予舒芬太尼1.2μg/kg、托烷司琼10 mg。比较两组患者静息、活动状态下的术后6 h(T1)、12 h(T2)、24 h(T3)、48 h(T4)时视觉模拟评分法(VAS)评分,术前(D0)、术后第1天(D1)、术后第3天(D3)简易精神状态评价量表(MMSE)评分及术后谵妄(POD)发生率,D0、D1、D3时焦虑自评量表(SAS)、抑郁自评量表(SDS)评分及抑郁发生率,术后不良反应发生率。结果静息、活动状态下,试验组T2、T3时的VAS评分低于对照组(P<0.05)。与D0时比较,两组D1时MMSE评分均显著下降(P<0.05)。D1时,试验组MMSE评分(26.35±0.98)分显著高于对照组的(25.73±0.85)分(P<0.05)。D0~D3时,对照组共有11例(27.5%)发生POD,试验组共有4例(10.0%)发生POD,试验组POD总发生率低于对照组(P<0.05)。D1、D3时,两组SAS、SDS评分均较本组D0时下降,且试验组SAS评分(38.93±3.79)、(37.85±3.54)分低于对照组的(41.88±3.02)、(39.68±3.56)分,SDS评分(47.93±3.75)、(45.08±3.95)分低于对照组的(49.93±2.52)、(47.85±3.85)分(P<0.05)。D0~D3时,试验组抑郁总发生率低于对照组,但差异无统计学意义(P>0.05)。试验组术后共4例(10.0%)发生恶心呕吐、嗜睡、头晕头痛、烦躁、疲劳等不良反应,对照组6例(15.0%)发生,比较差异无显著意义(P>0.05)。结论艾司氯胺酮能够降低老年肺癌患者胸腔镜肺叶切除术后焦虑、抑郁程度,改善术后第1天的认知功能,降低POD发生率。

Objective To evaluate the effects of esketamine on anxiety,depression and cognitive function in elderly patients with lung cancer after thoracoscopic lobectomy.Methods 80 elderly patients with lung cancer undergoing elective thoracoscopic lobectomy were randomly divided into an experimental group and a control group,with 40 cases in each group.General anesthesia was administered in both groups.The experimental group was given 0.2 mg/kg of esketamine intravenously at the time of induction of anaesthesia.Equal amounts of saline were administered to the control group.Post-operative analgesia with patient-controlled intravenous analgesia(PCIA):in the experimental group,1.2μg/kg of sufentanil,0.3 mg/kg of esketamine and 10 mg of tropisetron;in the control group,1.2μg/kg of sufentanil and 10 mg of tropisetron.Both groups were compared in terms of visual analogue scale(VAS)scores at 6 h postoperatively(T1),12 h postoperatively(T2),24 h postoperatively(T3)and 48 h postoperatively(T4)in resting and active state,mini-mental state examination(MMSE)score and incidence of postoperative delirium(POD)preoperatively(D0),postoperative day 1(D1)and postoperative day 3(D3),self-rating anxiety scale(SAS)and self-rating depression scale(SDS)scores and incidence of depression at D0,D1 and D3,and incidence of postoperative adverse reactions.Results In resting and active state,VAS scores at T2 and T3 in the experimental group were lower than those in the control group(P<0.05).Compared with D0,MMSE scores of both groups were significantly decreased on D1(P<0.05).On D1,MMSE score of(26.35±0.98)points in the experimental group was significantly higher than(25.73±0.85)points in the control group(P<0.05).On D0-D3 postoperatively,POD occurred in 11 cases(27.5%)in the control group and 4 cases(10.0%)in the experimental group.The total incidence of POD in the experimental group was lower than that in the control group(P<0.05).On D1 and D3,SAS and SDS scores in both groups decreased compared with those on D0 in this group;the SAS scores in the experimental group were(38.93±3.79)and(37.85±3.54)points,which were lower than(41.88±3.02)and(39.68±3.56)points in the control group;SDS scores in the experimental group were(47.93±3.75)and(45.08±3.95)points,which were lower than(49.93±2.52)and(47.85±3.85)points in the control group(P<0.05).On D0-D3,the total incidence of depression in the experimental group was lower than that in the control group,but the difference was not statistically significant(P>0.05).After surgery,4 cases(10.0%)of adverse reactions occurred in the experimental group,including nausea,vomiting,lethargy,dizziness and headache,irritability,fatigue.In the control group,6 cases(15.0%)of adverse reactions occurred,with no significant difference in comparison(P>0.05).Conclusion Esketamine can reduce the degree of postoperative anxiety and depression,improve cognitive cognition on postoperative day 1 in elderly patients with lung cancer undergoing thoracoscopic lobectomy,and reduce the incidence of POD.