艾司氯胺酮与布托啡诺用于乳腺癌术后镇痛对术后抑郁及镇痛效果的影响

Effects of esketamine and butorphanol on postoperative depression and analgesia in patients with breast cancer

目的观察艾司氯胺酮与布托啡诺用于乳腺癌术后镇痛对术后抑郁及镇痛效果的影响。方法收集中国人民解放军联勤保障部队第九七〇医院2023年3月至2024年3月甲乳外科于全身麻醉下行择期乳腺癌根治术的患者90例,年龄36~65岁,体质量指数(BMI)18.4~29.6 kg/m^(2),ASA分级Ⅰ/Ⅱ级。采用随机数字表法分为艾司氯胺酮与布托啡诺组(E组)及单纯布托啡诺组(B组),每组45例。两组患者均于全身麻醉下行手术治疗,术后均连接经静脉患者自控镇痛(PCIA),E组镇痛药物为艾司氯胺酮1 mg/kg+布托啡诺0.1 mg/kg+昂丹司琼16 mg,以生理盐水稀释至150 ml。B组镇痛药物为布托啡诺0.2 mg/kg+昂丹司琼16 mg,以生理盐水稀释至150 ml。记录两组患者术后2、4、6、12、24、36、48 h的静息视觉模拟评分(VAS)和运动时视觉模拟评分(VAS);记录患者术前1 d Ramsay镇静评分,术后2、4、6、12、24、36、48 h Ramsay镇静评分;记录两组患者术前1 d及术后1、3、5、7 d的汉密尔顿抑郁量表(HAMD)抑郁评分;记录两组患者术后静脉自控镇痛泵追加按压次数;统计两组患者术后VAS评分0~3分的例数及术后药物不良反应发生率。结果E组患者术后1、3、5、7 d的HAMD抑郁评分[(7.6±2.4)、(8.5±2.8)、(8.9±2.1)、(9.2±2.6)]均低于同时点B组患者[(9.4±2.7)、(10.1±3.3)、(11.5±3.6)、(12.7±3.3)],差异均有统计学意义(P均<0.01)。E组患者术后4、6、12、24、36、48 h的运动VAS评分[(2.6±0.8)、(2.9±0.9)、(3.1±0.6)、(3.4±0.8)、(3.3±0.8)、(3.1±0.5)]均低于同时间点B组患者[(3.1±0.5)、(3.3±0.7)、(3.5±0.4)、(3.9±0.6)、(3.7±0.7)、(3.4±0.8)],差异均有统计学意义(P均<0.05)。术后48 h内按压镇痛追加次数E组(6.6±1.8)次少于B组(8.8±1.6)次,差异有统计学意义(P<0.05)。患者术后VAS评分0~3分的例数E组38例大于B组31例,差异有统计学意义(P<0.05)。两组患者术后2、4、6、12、24、36、48 h的静息VAS评分差异均无统计学意义(P>0.05)。E组患者术后12、24、36、48 h Ramsay镇静评分均高于B组,差异均有统计学意义(P均<0.05)。结论艾司氯胺酮与布托啡诺用于乳腺癌患者术后镇痛,具有更好的镇痛、镇静作用,可减轻患者术后运动疼痛;艾司氯胺酮能降低患者术后抑郁的发生。

Objective To observe the effect of esketamine and butorphanol on postoperative depression and analgesia in patients after breast cancer surgery.Methods From March 2023 to March 2024,90 patients with breast cancer undergoing elective radical mastectomy under general anesthesia in the Department of Breast Surgery in 970th Hospital of the PLA Joint Logistic Support Force,were collected.The patients aged 36 to 65 years old,body mass index(BMI)18.4 to 29.6 kg/m^(2) and ASA gradeⅠ/Ⅱ,were divided into two groups by a random number table method:esketamine and butorphanol group(group E,n=45),butorphanol alone group(group B,n=45).All patients received general anesthesia and postoperative patient-controlled intravenous analgesia(PCIA),esketamine 1 mg/kg,butorphanol 0.1 mg/kg,and ondansetron 16 mg,diluted with physiological saline to 150 ml in group E;and butorphanol 0.2 mg/kg and ondansetron 16 mg,diluted with physiological saline to 150 ml in group B.The rest visual analogue scale(VAS)and motion VAS,Ramsay sedation score and Hamilton Depression Rating Scale(HAMD)were recorded respectively at 2,4,6,12,24,36,and 48 h after the operation in two groups.The times of pressions PCA,the patients with VAS 0-3 and the incidence of postoperative adverse drug reactions were record in two groups.Results The HAMD scores were lower in group E[(7.6±2.4),(8.5±2.8),(8.9±2.1),(9.2±2.6)]than that in group B[(9.4±2.7),(10.1±3.3),(11.5±3.6),(12.7±3.3)]on the 1st,3rd,5th and 7th day after the operation(all P<0.01).The motion VAS were lower in group E[(2.6±0.8),(2.9±0.9),(3.1±0.6),(3.4±0.8),(3.3±0.8),(3.1±0.5)]than that in group B[(3.1±0.5),(3.3±0.7),(3.5±0.4),(3.9±0.6),(3.7±0.7),(3.4±0.8)]at 4,6,12,24,36 and 48 h after operation(all P<0.05).The times of pressing PCA were less in group E(6.6±1.8)than that in group B(8.8±1.6)within 48 h after the operation(P<0.05).The patients number of VAS 0-3 was higher in group E(38 cases)than that in group B(31 cases)(P<0.05).The rest VAS had no significant difference between the two groups at 2,4,6,12,24,36,48 h after the operation(P>0.05).The Ramsay sedation scores were higher in group E than that in group B at 12,24,36,48 h after the operation(all P<0.05).Conclusion Esketamine and butorphanol have better analgesic and sedative effects for postoperative analgesia in patients with breast cancer,and reduce the incidence of postoperative depression.