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| 艾司氯胺酮在肺癌手术患者早期戒烟中的应用效果 |
| Effects of esketamine in early smoking cessation of patients undergoing lung cancer surgery |
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| DOI：10.12089/jca.2025.01.013 |
| 中文关键词: 艾司氯胺酮 戒烟 肺癌 抑郁 焦虑 |
| 英文关键词: Esketamine Somking cessation Lung cancer Depression Anxiety |
| 基金项目:浙江省医药卫生科技项目（2024KY681，2023KY048）；浙江省高校基本科研专项资助（KYZD2023007） |
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| 中文摘要: |
目的：评价艾司氯胺酮在肺癌手术患者早期戒烟中的应用效果。
方法：选择择期行胸腔镜肺癌切除术的吸烟患者174例，男144例，女30例，年龄18～64岁，BMI 18.5～30.0 kg/m2，ASA Ⅰ—Ⅲ级。采用随机数字表法将患者分为两组:艾司氯胺酮组（E组，n=86）和对照组（C组，n=88）。E组在术前3周至术后1周给予艾司氯胺酮0.5 mg/kg喷鼻治疗，每周1次，每次间隔1周，共4次；C组给予同等容量及频次的生理盐水喷鼻。计算末次治疗后随访6个月的戒烟成功率（过去2周吸烟≤5支，并且一氧化碳检测<百万分之十）。记录吸烟相关并发症及尼古丁依赖评分情况。采用汉密尔顿抑郁量表（HDRS-24）评估治疗第1～4周抑郁症状变化，采用广泛性焦虑障碍量表（GAD-7）评估治疗第1～4周焦虑症状变化，采用临床分离状态量表（CADSS）评估治疗期间的不良反应。
结果：与C组比较，E组戒烟成功率明显升高（P<0.05），咳嗽、咳痰发生率明显降低（P<0.05），尼古丁依赖评分明显降低（P<0.05），在治疗第1～4周HDRS-24评分及GAD-7评分明显降低（P<0.05），治疗期间头晕和嗜睡发生率明显升高（P<0.05）。
结论：艾司氯胺酮可提高肺癌手术患者早期戒烟成功率，并减少吸烟相关并发症和减轻抑郁焦虑症状。 |
| 英文摘要: |
Objective: To investigate the effect of esketamine in early smoking cessation of patients undergoing lung cancer surgery.
Methods: A total of 174 patients, 144 males and 30 females, aged 18-64 years, BMI 18.5-30.0 kg/m2, ASA physical status Ⅰ-Ⅲ, scheduled for thoracoscopic lung cancer resection surgery were divided into two groups by random number table method: esketamine group (group E, n = 86) and control group (group C, n = 88). From three weeks before sugery to one week after surgery, the patients in group E were intranasally delivered by esketamine 0.5 mg/kg once a week for continuous 4 sessions. The patients in group C were intranasally delivered by saline with equal volume and frequency. The successful rates of smoking cessation 6 months after the last treatment session was calculted. Successful sustained abstinence was defined as smoking no more than five cigarettes in the passed 2 weeks, and carbon monoxide level of less than 10 parts per million. The changes of smoking-related symptoms and nicotine dependence score were recorded. The status of depression was evaluated by the 24-item Hamilton depression rating scale (HDRS-24) in 1-4 weeks of treatment. The status of anxiety was examined by the generalized anxiety disorder-7 (GAD-7) in 1-4 weeks of treatment. The clinician administered dissociative states scale (CADSS) was used to evaluate drugs induced dissociation symptoms during the treatment.
Results: Compared with group C, the successful rate of smoking cessation in group E was significantly increased (P < 0.05), the incidence of cough and phlegm were significantly decreased (P < 0.05), the nicotine dependence score was significantly decreased (P < 0.05), the HDRS-24 and GAD-7 scores were significantly decreased in 1-4 weeks of treatmen (P < 0.05), the incidence of dizziness and somnolence during the treatment were significantly increased (P < 0.05).
Conclusion: Esketamine can raise the successful rate of early smoking cessation of patients undergoing lung cancer surgery, and decrease the smoking-related symptoms and the severity of depression and anxiety. |
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