文章摘要
不同剂量艾司氯胺酮对术前焦虑患者胸腔镜手术后早期情绪的影响
Effect of different doses of esketamine on early mood in patients with preoperative anxiety after thoracoscopic surgery
  
DOI：10.12089/jca.2024.02.007
中文关键词: 艾司氯胺酮  胸腔镜手术  术后疼痛  焦虑
英文关键词: Esketamine  Thoracoscopic surgery  Postoperative pain  Anxiety
基金项目:南京医科大学科技发展基金项目（NMUB2020334）
作者单位E-mail
吴冰清 225009,扬州大学医学院（现在南京市浦口人民医院麻醉科）  
佘汗涛 南京市浦口人民医院麻醉科  
高铁梅 南京市浦口人民医院麻醉科  
陈晨 225009,扬州大学医学院 chenchennjmu@outlook.com 
摘要点击次数: 339
全文下载次数: 221
中文摘要:
      
目的：观察不同剂量艾司氯胺酮对术前焦虑患者胸腔镜手术后早期情绪的影响。
方法：选择存在术前焦虑的胸腔镜手术患者80例，男37例，女43例，年龄25～64岁，BMI 18～26 kg/m2，ASA Ⅰ—Ⅲ级。采用随机数字表法将患者分为四组：对照组（C组）、艾司氯胺酮0.1 mg/kg组（E1组）、艾司氯胺酮0.2 mg/kg组（E2组）和艾司氯胺酮0.3 mg/kg组（E3组），每组20例。E1组、E2组和E3组于手术结束前30 min分别静脉缓慢注射相应剂量艾司氯胺酮，C组给予等容量生理盐水10 ml。记录术前24 h、术后24、48、72、120 h的7项广泛性焦虑障碍量表（GAD-7）评分和医院焦虑抑郁量表（HADS）评分，并抽取外周静脉血5 ml，采用ELISA法检测血清脑源性神经营养因子（BDNF）浓度。记录术后12、24 h静息和活动时NRS疼痛评分。记录术后48 h内补救镇痛例数和镇痛泵有效按压次数。
结果：与C组比较，E1组、E2组和E3组术后24、48、72 h的GAD-7评分和HADS评分明显降低，且E3组明显低于E1组和E2组（P<0.05）；E1组、E2组和E3组术后24、48、72 h血清BDNF浓度明显升高（P<0.05），且E3组明显高于E1组和E2组（P<0.05）。与C组比较，E1组、E2组和E3组术后12、24 h静息时NRS疼痛评分及术后12 h活动时NRS疼痛评分明显降低（P<0.05），且E3组明显低于E1组和E2组（P<0.05）；E1组、E2组和E3组术后48 h内补救镇痛例数和镇痛泵有效按压次数明显减少（P<0.05），且E3组明显少于E1组和E2组（P<0.05）。
结论：单次静脉注射艾司氯胺酮0.1、0.2、0.3 mg/kg可改善胸腔镜手术前焦虑患者的术后早期情绪，其中艾司氯胺酮0.3 mg/kg抗焦虑效果更好。
英文摘要:
      
Objective: To observe the effect of different doses of esketamine on early mood in patients with preoperative anxiety after thoracoscopic surgery.
Methods: Eighty patients with preoperative anxiety before thoracoscopic surgery, 37 males and 43 females, aged 25-64 years, BMI 18-26 kg/m2, ASA physical status Ⅰ-Ⅲ were selected. According to random number table, the patients were randomly divided into four groups: control group (group C), esketamine 0.1 mg/kg group (group E1), esketamine 0.2 mg/kg group (group E2), and esketamine 0.3 mg/kg group (group E3), 20 patients in each group. In groups E1, E2, and E3, the patients were slowly injected with corresponding doses of esketamine intravenously 30 minutes before the end of the operation, and the patients in group C were given 10 ml of normal saline at the same time. The 7-item generalized anxiety disorder scale (GAD-7) score and hospital anxiety and depression scale (HADS) score were evaluated 24 hours before surgery, 24, 48, 72, and 120 hours after surgery, respectively. Peripheral venous blood (5 ml) was collected at the same time points, and serum brain-derived neurotrophic factor (BDNF) concentration was detected by ELISA. NRS scores at rest and exercise were recorded 12 and 24 hours after surgery. The number of remedial analgesia and the number of effective compressions of analgesia pump within 48 hours after surgery were recorded.
Results: Compared with group C, the scores of GAD-7 and HADS in groups E1, E2, and E3 were significantly decreased 24, 48, and 72 hours after surgery (P < 0.05). And compared with groups E1 and E2, the scores of GAD-7 and HADS in group E3 were significantly lower (P < 0.05). The serum BDNF level in groups E1, E2, and E3 were significantly increased compared with group C 24, 48, and 72 hours after surgery (P < 0.05). Compared with group E1 and E2, the serum BDNF level in group E3 was significantly higher (P < 0.05). Compared with group C, the NRS scores at rest 12 and 24 hours and the scores at exercise 12 hours after surgery in groups E1, E2, and E3 were significantly decreased (P < 0.05). And compared with groups E1 and E2, the scores in group E3 were significantly lower (P < 0.05). The number of postoperative remedial analgesia and the number of effective compressions of analgesia pump in groups E1, E2, and E3 were significantly decreased compared with group C within 48 hours after surgery (P < 0.05). And compared with groups E1 and E2, the number in group E3 was significantly lower (P < 0.05).
Conclusion: Single intravenous injection of esketamine 0.1, 0.2, and 0.3 mg/kg can improve early postoperative mood of patients with anxiety before thoracoscopic surgery, and esketamine 0.3 mg/kg has better anti-anxiety effect.
查看全文   查看/发表评论  下载PDF阅读器
关闭