乳腺癌改良根治术后应用艾司氯胺酮对患者镇痛、认知功能和恢复质量的影响

Effects of esketamine on analgesia,cognitive function and recovery quality after modified radical mastectomy for breast cancer

目的探究艾司氯胺酮对行乳腺癌改良根治术(MRM)的患者术后镇痛效果、认知功能和恢复质量的影响。方法选取2020年6月至2022年12月于浙江新安国际医院确诊并进行MRM的女性患者80例,随机分为对照组和观察组,每组40例。两组患者术中处理一致,术后镇痛方式不同,对照组采用舒芬太尼,观察组采用舒芬太尼联合艾司氯胺酮。比较两组患者40项恢复质量量表(QoR-40)评分、视觉模拟量表(VAS)评分、蒙特利尔认知评估量表(MoCA)评分及术后48 h内镇痛泵有效按压次数的差异。结果①观察组术后1 d时QoR-40评分中的情绪状态和疼痛维度项高于对照组,术后2 d时身体舒适度、情绪状态和疼痛维度评分均高于对照组(P<0.05)。②术后VAS评分和镇痛泵按压次数,观察组均低于对照组(P<0.05)。③与对照组术前1 d相比,观察组MoCA评分在术后1 d变化不明显(P>0.05),观察组术后3~5 d的MoCA评分均显著增高(P<0.05)。④两组患者术后3 d内总不良反应发生率无显著性差异(P>0.05)。结论术后应用艾司氯胺酮能够增强乳腺癌根治术后镇痛效果,改善患者身体不适和情绪状态,利于术后认知功能恢复。

Objective To explore the effects of esketamine on analgesic effect,cognitive function and recovery quality in patients undergoing modified radical mastectomy(MRM).Methods A total of 80 female patients diagnosed and underwent MRM in Zhejiang Xin an International Hospital from June 2020 to December 2022 were selected and randomly divided into control group and observation group,with 40 cases in each group.Introperative treatment was consistent between the two groups.Sufentanil was applied to the control group for analgesia and sufentanil combined with esketamine was applied to the observation group for analgesia.The differences of 40-item Quality of Recovery Scale(QoR-40)scores,Visual Analogue Scale(VAS)scores,Montreal Cognitive Assessment Scale(MoCA)scores and the number of effective analgesic pump compressions within 48 h after surgery were compared between the two groups.Results① The emotional state and pain dimension in the QoR-40 score of the observation group were higher than those of the control group 1 d after surgery,and the physical comfort,emotional state and pain dimension scores were higher than those of the control group 2 d after surgery(P<0.05).② Postoperative VAS scores and the number of analgesic pump compressions were lower in the observation group than those in the control group(P<0.05).③ Compared with the control group 1 d before surgery,the MoCA score of the observation group had no significant change 1 d after surgery(P>0.05),and the MoCA score of the observation group 35 d after surgery was significantly increased(P<0.05).④ There was no significant difference in the incidence of total adverse reactions within 3 d after surgery between the two groups(P>0.05).Conclusion Postoperative application of esketamine can enhance the analgesic effect after radical mastectomy for breast cancer,improve the physical discomfort and emotional state of patients,and facilitate the recovery of postoperative cognitive function.