艾司氯胺酮切皮前用药对腹腔镜全子宫切除术后患者抑郁情绪与睡眠质量的影响

Effects of esketamine used before the skin incision of patients with laparoscopic total hysterectomy on their postoperative depression and sleep quality

目的:探讨腹腔镜全子宫切除术(LTH)切皮前艾司氯胺酮用药镇痛效果。方法:选取2021年2月-2023年5月本院LTH患者110例,随机数字表法分为2组各55例。均择期行全麻下LTH治疗,观察组于切皮前予以艾司氯胺酮0.3 mg/kg静脉注射、对照组同时间点予以同剂量生理盐水注射。统计两组各时间点17项汉密尔顿抑郁量表(HAMD-17)、数字评定量表(NRS)以及匹兹堡睡眠质量指数(PSQI)评分,比较两组血清神经递质[多巴胺(DA)、肾上腺素(E)、去甲肾上腺素(NE)]水平,统计不良反应。结果:观察组剔除术中转开腹1例、个人因素退出1例,纳入53例;对照组剔除数据不全1例,纳入54例。观察组术后4 h、12 h、24 h、48 h静息时NRS评分(2.27±0.36分、2.53±0.41分、2.40±0.30分、2.12±0.32分)均低于对照组(2.62±0.40分、3.08±0.46分、2.85±0.38分、2.52±0.42分),术后2 d和5 d HAMD-17评分(13.24±2.16分、10.16±2.42分)、PSQI评分(12.46±1.84分、9.35±1.75分)均低于对照组(15.07±2.33分、11.59±2.51分、13.85±2.13分、10.08±1.92分),术后5 d观察组血清NE(129.45±17.25ng/L)、E(33.46±5.42ng/L)及DA(7.37±0.86μg/L)水平均高于对照组(113.62±13.48ng/L、30.72±4.15ng/L、7.03±0.72μg/L)(均P<0.05)。观察组不良反应总发生率(17.0%)与对照组(14.8%)无差异(P>0.05)。结论:艾司氯胺酮切皮前用药可减轻LTH患者术后疼痛,调节神经递质表达水平,改善抑郁、睡眠状态,且未增加不良反应。

Objective:To investigate the application efficacy of esketamine used before the skin incision of patients with laparoscopic total hysterectomy(LTH)on their postoperative depression and sleep quality.Methods:From February2021 to May 2023,110 patients with LTH were selected and were randomly divided into two groups(55 cases in each group)by random number table.All these patients were given treated with the selective LTH under general anesthesia.The patients in observation group were given intravenous injection of esketamine 0.3 mg/kg before skin incision,and the pa-tients in control group were injected with the same dose of normal saline at the same time point.The scores of Hamilton de-pression scale-17(HAMD-17),numeric rating scales(NRS)and Pittsburgh sleep quality index(PSQI)of the patients in the two groups at each time point were calculated.The levels of the serum neurotransmitters,such as dopamine(DA),epinephrine(E),norepinephrine(NE),of the patients were compared between the two groups.And the adverse reaction rates of the patients in the two groups were counted.Results:In observation group,53 patients were included for analysis after excluding 1 case of conversion to open surgery and 1 case of with-drawal due to personal factors.In control group,1 patient with incomplete data was excluded,and 54 patients were included for analysis.The NRS scores at rest of the patients at 4 h,12 h,24 h,48 h after operation in observation group were 2.27±0.36points,2.53±0.41 points,2.40±0.30 points and 2.12±0.32 points,respectively,which were significantly lower than those(2.62±0.40 points,3.08±0.46 points,2.85±0.38 points and 2.52±0.42 points)of the patients in control group.The HAMD-17 score in the 2nd day and in the 5th day after operation(13.24±2.16 points and 10.16±2.42points.)and the PSQI score in the 2nd day and in the 5th day after operation(12.46±1.34 points and 9.35±1.75points)of the patients in observation group were significantly lower than those(15.07±2.33 points and 11.59±2.51points,13.85±2.13 points and 10.08±1.92 points)of the patients in control group.The levels of serum norepinephrine(NE)(129.45±17.25 ng/L),epinephrine(E)(33.46±5.42 ng/L)and DA(7.02±1.16μg/L)of the patients in observation group in the 5th day after operation were significantly higher than those(113.62±13.48 ng/L,30.72±4.15 ng/L,7.03±0.72μg/L)of the patients in control group(all P<0.05).There was no significant difference in the total incidence of the adverse reactions of the patients between the observation group(17.0%)and the control group(14.8%)(P>0.05).Conclusions:Esketamine used before the skin incision of the patients with LTH can alleviate their postoperative pain,regulate their expression level of neurotransmitters,and improve their depression and sleep status,and without increasing the adverse reactions.