文章摘要
小剂量艾司氯胺酮对乳腺癌手术患者术后睡眠质量的影响
Effect of low-dose esketamine on postoperative sleep quality in patients undergoing breast cancer surgery
  
DOI：10.12089/jca.2024.12.011
中文关键词: 艾司氯胺酮  乳腺癌  全身麻醉  术后睡眠
英文关键词: Esketamine  Breast cancer  General anesthesia  Postoperative sleep
基金项目:
作者单位E-mail
时明章 236000,蚌埠医科大学附属阜阳医院,阜阳市人民医院麻醉科  
代晨旭 236000,蚌埠医科大学附属阜阳医院,阜阳市人民医院麻醉科  
官双双 236000,蚌埠医科大学附属阜阳医院,阜阳市人民医院麻醉科  
王秋锋 236000,蚌埠医科大学附属阜阳医院,阜阳市人民医院麻醉科  
蔡宁 236000,蚌埠医科大学附属阜阳医院,阜阳市人民医院麻醉科 cn0049@163.com 
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中文摘要:
      
目的：探讨术前静注艾司氯胺酮0.25 mg/kg对乳腺癌患者术后睡眠质量的影响。
方法：选择择期全身麻醉下行乳腺癌根治术的女性患者70例，年龄35～64岁，BMI 18.5～34.0 kg/m 2，ASA Ⅰ或Ⅱ级。采用随机数字表法将患者分为两组：艾司氯胺酮组（E组）和对照组（C组），每组35例。E组患者于麻醉诱导时静脉注射艾司氯胺酮0.25 mg/kg，C组患者静脉注射等容生理盐水。术前1 d和术后1、2、3 d使用Richards Campbell睡眠问卷（RCSQ）评估主观睡眠质量，穿戴设备Fitbit记录睡眠效率和浅睡眠、深睡眠、快动眼（REM）睡眠时间占比。记录术后1、2、3 d VAS疼痛评分，拔管时间、瑞芬太尼用量、补救镇痛例数，恶心呕吐和头晕等不良反应发生情况。
结果：与术前1 d比较，术后1、2、3 d两组RCSQ评分、睡眠效率明显降低（P＜0.05），C组深睡眠、REM睡眠比例明显降低（P＜0.05），浅睡眠比例明显升高（P＜0.05）。与C组比较，术后1、2、3 d E组RCSQ评分、睡眠效率、深睡眠和REM睡眠比例明显升高（P＜0.05），浅睡眠比例明显降低（P＜0.05），术后1、2、3 d VAS疼痛评分明显降低（P＜0.05）。两组拔管时间、瑞芬太尼用量、补救镇痛率、不良反应发生情况差异无统计学意义。
结论：术前静脉注射艾司氯胺酮0.25 mg/kg可以改善乳腺癌患者术后睡眠质量、减轻术后疼痛，且不增加不良反应。
英文摘要:
      
Objective: To investigate the effect of intravenous inject esketamine 0.25 mg/kg before surgery on postoperative sleep quality in breast cancer patients.
Methods: Seventy female patients under elective general anesthesia for radical mastectomy, aged 35-64 years, BMI 18.5-34.0 kg/m 2, ASA physical status Ⅰ or Ⅱ were selected. The patients were divided into two groups using the random number table method: esketamine group (group E) and control group (group C), 35 patients in each group. Group E received an intravenous injection of esketamine 0.25 mg/kg during anesthesia induction, while group C received a constant volume of saline. Subjective sleep quality was assessed using the Richards Campbell sleep questionnaire (RCSQ) 1 day before surgery and 1 day to 3 days after surgery, and sleep efficiency as well as the proportion of light, deep, and rapid eye movement (REM) sleep time were recorded using the wearable device Fitbit. Pain was assessed by the VAS pain score at 1 day to 3 days after surgery. Time of extubation, remifentanil dosage, number of remedial analgesia cases, and adverse effects such as nausea and vomiting and dizziness were recorded.
Results: Compared with 1 day before surgery, the RCSQ scores and sleep efficiency were significantly lower in both groups 1 day to 3 days after surgery (P < 0.05), and the proportion of deep sleep and REM sleep was significantly lower and the proportion of light sleep was significantly higher in group C (P < 0.05). Compared with group C, RCSQ scores, sleep efficiency, the proportion of deep and REM sleep time were significantly higher (P < 0.05), and the proportion of light sleep time was significantly lower in group E 1 day to 3 days after surgery (P < 0.05), VAS pain scores were significantly lower 1 day to 3 days after surgery (P < 0.05). There was no significant difference in the time of extubation, remifentanil dosage, number of remedial analgesia cases, and adverse effects between the two groups.
Conclusion: Intravenous injection of esketamine 0.25 mg/kg before surgery can improve postoperative sleep quality and reduce postoperative pain in breast cancer patients, and no increase in adverse effects.
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