艾司氯胺酮用于乳腺癌根治术后镇痛的效果及对患者焦虑抑郁情绪的影响

Effect of esketamine on postoperative analgesia for breast cancer radical mastectomy and its influence on anxiety and depression

目的探讨艾司氯胺酮用于乳腺癌根治术后镇痛的效果及对患者焦虑抑郁情绪的影响。方法队列研究。抽取2022年7月至2023年7月郑州大学第一附属医院收治的全身麻醉下择期行乳腺癌根治术的女性患者92例,按照随机数字表法分为对照组与艾司氯胺酮组,每组46例。艾司氯胺酮组麻醉诱导和术后自控静脉镇痛分别采用艾司氯胺酮0.5 mg/kg和1.0 mg/kg,对照组分别采用舒芬太尼0.4μg/kg和2.0μg/kg,两组其他用药均相同。记录术后4、12、24、48 h的视觉模拟评分法(VAS)评分和Steward苏醒评分。观察镇痛泵使用期间头晕、恶心呕吐、呼吸抑制、皮肤瘙痒、肛门排气及补救镇痛的情况。采用焦虑抑郁量表(HADS)评估患者手术前后的焦虑和抑郁情绪。结果术后4、8 h,艾司氯胺酮组VAS评分均低于对照组(P均<0.05)。艾司氯胺酮组恶心呕吐发生率和镇痛补救率均低于对照组(P<0.05);艾司氯胺酮组术后排气时间少于对照组(P<0.05)。术后3 d,艾司氯胺酮组HADS评分、焦虑和抑郁发生率低于对照组(P<0.05)。结论艾司氯胺酮可优化乳腺癌根治术后的镇痛效果,缓解患者术后的焦虑抑郁情绪。

Objective To investigate the effect of esketamine on postoperative analgesia for breast cancer radical mastectomy and its influence on anxiety and depression.Methods A total of 92 female patients admitted to the First Affiliated Hospital of Zhengzhou University from July 2022 to July 2023 who underwent elective radical mastectomy under general anesthesia were selected for the cohort study,and they were divided into a control group and an esketamine group according to random number table method,with 46 cases in each group.The esketamine group was given esketamine 0.5 mg/kg for anesthesia induction and esketamine 1 mg/kg for postoperative self-controlled intravenous analgesia;the control group was given sufentanil 0.4μg/kg and 2μg/kg,respectively.Other drugs were the same in both groups.The visual analogue scale(VAS)score and Steward awakening score at 4,12,24,and 48 hours after surgery were recorded.The incidence of dizziness,nausea and vomiting,respiratory depression,skin itching,anal discharge,and remedy anesthesia during the use of the analgesic pump were observed.The anxiety and depression emotion was evaluated using hospital anxiety and depression scale(HADS).Results At 4 and 8 hours after surgery,the VAS score of the esketamine group was lower than that of the control group(all P<0.05).The incidence of nausea and vomiting,added analgesic rate in the esketamine group were significantly lower than those in the control group(P<0.05);the postoperative exhaust time in the esketamine group was shorter than that in the control group(P<0.05).The HADS score,incidence of anxiety and depression in the esketamine group were lower than those in the control group 3 days after surgery(P<0.05).Conclusions Esketamine can alleviate the pain after radical mastectomy in breast cancer patients,and relieve their anxiety and depression.