小剂量艾司氯胺酮术后镇痛对胃肠道肿瘤患者术后抑郁的影响

Effect of low-dose esketamine for postoperative analgesia on postoperative depression in patients with gastrointestinal tumors

目的评价小剂量艾司氯胺酮术后镇痛对胃肠道肿瘤患者术后抑郁的影响。方法本研究为前瞻性随机对照研究。选取本院2023年6月至11月择期全身麻醉下行胃肠肿瘤手术患者80例,性别不限,年龄18~64岁,BMI 18~25 kg/m^(2),ASA分级Ⅱ或Ⅲ级。采用随机数字表法分为2组(n=40):艾司氯胺酮组(E组)和对照组(C组)。2组术后均行PCIA,E组PCIA药物配置方案:艾司氯胺酮0.5 mg/kg、地佐辛0.5 mg/kg、右美托咪定1.5μg/kg和氟比洛芬酯100 mg,用生理盐水稀释至100 ml;C组PCIA药物配置方案:地佐辛0.5 mg/kg、右美托咪定1.5μg/kg和氟比洛芬酯100 mg,用生理盐水稀释至100 ml。于术前1 d、术后2 d采用综合医院焦虑抑郁自评量表(HADS)评估焦虑(HADS-A评分)和抑郁(HADS-D评分)情况。采用15项恢复质量量表(QoR-15)评估术后早期恢复质量;记录术后VAS评分、镇痛泵按压次数、补救镇痛次数和药物相关不良反应发生情况。结果最终纳入78例患者,E组39例,C组39例。与C组比较,E组术后HADS-D评分和抑郁发生率降低,QoR-15评分升高,VAS评分降低(P<0.05),术后HADS-A评分和焦虑发生率、镇痛泵按压次数,补救镇痛次数差异无统计学意义(P>0.05)。E组1例患者术后1 d出现幻视,术后2 d即缓解。2组术后头晕、恶心呕吐发生率比较差异无统计学意义(P>0.05)。结论0.5 mg/kg艾司氯胺酮术后镇痛可缓解胃肠肿瘤患者术后抑郁症状,增强镇痛效果,改善术后早期恢复质量。

Objective To evaluate the effect of low-dose esketamine for postoperative analgesia on the postoperative depression in patients with gastrointestinal tumors.Methods This study was a prospective randomized controlled trial.Eighty patients,aged 18-64 yr,with a body mass index of 18-25 kg/m^(2),of American Society of Anesthesiologists Physical Status classificationⅡorⅢ,scheduled for elective radical resection of the gastrointestinal tumor under general anesthesia from June to November 2023 in our hospital,were divided into 2 groups(n=40 each)using a random number table method:esketamine group(group E)and control group(group C).Each patient received postoperative patient-controlled intravenous analgesia(PCIA).The PCIA solution in group E contained esketamine 0.5 mg/kg,dezocine 0.5 mg/kg,dexmetomidine 1.5μg/kg and flurbiprofen ester 100 mg in 100 ml of normal saline.The PCIA solution in group C contained dezocine 0.5 mg/kg,dexmetomidine 1.5μg/kg and flurbiprofen ester 100 mg in 100 ml of normal saline.The Hospital Anxiety and Depression Scale(HADS)was used to assess the patients′anxiety and depression at 1 day before operation(T 0)and 2 days after operation(T 1).The Quality of Recovery-15 scale was used to evaluate the early postoperative recovery quality.Visual analog scale scores,the pressing times of patient-controlled analgesia and the number of rescue analgesia were recorded within 2 days after operation.The occurrence of drug-related adverse reactions was also recorded.Results Seventy-eight patients were finally included,with 39 cases in group E and 39 cases in group C.Compared with group C,the postoperative HADS-depression scale score and incidence of depression were significantly decreased,the Quality of Recovery-15 scale score was increased,the visual analog scale scores were decreased(P<0.05),and no significant changes were found in the postoperative HADS-anxiety scale score and incidence of anxiety,the pressing times of patient-controlled analgesia and the number of rescue analgesia in group E(P>0.05).Visual hallucination was found at 1 day after operation in one patient and relieved at 2 days after operation in group E.There was no significant difference in the incidence of postoperative dizziness,nausea and vomiting between the two groups(P>0.05).Conclusions Postoperative analgesia with 0.5 mg/kg esketamine can alleviate postoperative depressive symptoms,enhance the efficacy of analgesia and improve the early postoperative recovery quality in patients with gastrointestinal tumors.