不同剂量艾司氯胺酮对乳腺癌患者术后疼痛和抑郁的影响

Effects of different doses of esketamine on postoperative pain and depression in patients with breast cancer

目的探讨静脉注射不同剂量艾司氯胺酮对乳腺癌患者术后疼痛和抑郁的影响。方法选取海安市中医院择期全身麻醉下行乳腺癌根治手术的女性患者120例,以电脑随机数字表法分为对照组、低剂量组、高剂量组,每组40例。所有患者均采用相同的麻醉药物诱导,气管插管后对照组静脉注射0.9%生理盐水5 mL,并在术中以10 mL/h进行静脉滴注。低剂量组将艾司氯胺酮按1.5 mg/kg用量,以0.9%的生理盐水稀释至50 mL,气管插管后静脉注射5 mL,并以5 mL/h静脉泵注直至手术结束。高剂量组将艾司氯胺酮按2.5 mg/kg用量,以0.9%的生理盐水稀释至50 mL,气管插管后静脉注射5 mL,并以5 mL/h静脉泵注直至手术结束。比较3组患者术中及术后24 h、48 h阿片类药物用量,术后4 h、8 h、24 h、48 h、术后1个月、术后3个月视觉模拟量表(Visual analogue scale,VAS)评分,术后1周、1个月、3个月汉密顿抑郁量表(Hamilton depression scale-17,HAMD-17)和恢复质量15项量表(Quality of recovery-15 scale,QOR-15)评分以及不良反应发生率。结果对照组、低剂量组、高剂量组有效受试者分别为38例、40例、39例。低剂量组术中、术后24 h舒芬太尼用量均低于对照组,高剂量组术中、术后24 h、术后48 h舒芬太尼用量均低于对照组、低剂量组(P<0.05)。高剂量组术后4 h、8 h、24 h、48 h、1个月、3个月的VAS评分均低于对照组,高剂量组术后4 h、8 h、24 h的VAS评分均低于低剂量组(P<0.05)。高剂量组术后1周、术后1个月、术后3个月的HAMD-17评分均低于对照组,低剂量组术后1周的HAMD-17评分低于对照组,高剂量组术后1个月、术后3个月的HAMD-17评分均低于低剂量组(P<0.05)。3组术后48 h内不良反应发生率和术后1周、术后1个月、术后3个月QOR-15评分比较,差异均无统计学意义(P>0.05)。结论低剂量与高剂量艾司氯胺酮均可缓解乳腺癌术后疼痛,改善抑郁状态,而高剂量艾司氯胺酮的抑制术后疼痛和改善抑郁状态的效果更为显著和持久。

Objective To compare the effects of different doses of intravenous esketamine on postoperativepain and depression in patients withbreast cancer.Methods 120 female patients who underwent radical surgery of breast cancer under selective general anesthesia in the hospital were selected and divided into control group,low-dose group and high-dose group by computer random number table,with 40 cases per group.All patients were induced with the same anesthetic,and after tracheal intubation,the control group was intravenously injected with 5 mL of 0.9%physiological saline,and intravenously pumped at a rate of 10 mL/h during surgery.The low-dose group received a dosage of 1.5 mg/kg of ketamine,diluted to 50 mL with 0.9%physiological saline,followed by intravenous injection of 5mL after tracheal intubation,followed by intravenous pumping at a rate of 5mL/h until the end of the surgery.In the high-dose group,ketamine was diluted to 50 mL with 0.9%physiological saline at a dosage of 2.5 mg/kg.5 mL was intravenously injected after tracheal intubation,followed by intravenous infusion at a rate of 5 mL/h until the end of the surgery.The amount of opioid drugs used during and 24 and 48 hours after surgery were compared among 3 groups.Visual analog scale(VAS)scores at 4 hours,8 hours,24 hours,48 hours,1 month and 3 months after surgery were compared.The hamilton depression scale-17(HAMD-17)and Quality of Recovery 15(QOR-15)scores were evaluatedat1 week,1 month,and 3 months after the surgery.The incidence of adverse reaction were compared.Results The effective subjects in the control group,low-dose group,and high-dose group were 38,40 and 39 respectively.The dosage of sufentanil in the low-dose group during surgery and 24 hours after surgery was lower than that in the control group,while the dosage of sufentanil in the high-dose group during surgery,24 hours after the surgery and 48 hours after the surgery was lower than that in the control group and low-dose group(P<0.05).The VAS scores of the high-dose group at 4 hours,8 hours,24 hours,48 hours,1 month and 3 months postoperatively were lower than those of the control group,while the VAS scores of the high-dose group at 4 hours,8 hours and 24 hours postoperatively were lower than those of the low-dose group(P<0.05).The HAMD-17 scores of the high-dose group were lower than those of the control group at 1 week,1 month and 3 months after the surgery.The HAMD-17 scores of the low-dose group were lower than those of the control group at 1 week after surgery,while the HAMD-17 scores of the high-dose group were lower than those of the low-dose group at 1 month and 3 months after the surgery(P<0.05).There was no significant difference in the incidence of adverse reactions within 48 hours and QOR-15 score at 1 week,1 month and 3 months after the operation between the 3 groups(P>0.05).Conclusion Both low-dose and high-dose esketamine can alleviate postoperative pain and depression in breast cancer patients,while high-dose esketamine has more significant and lasting effect in inhibiting postoperative pain and depressiony.