摘要
目的:探讨艾司氯胺酮对乳腺癌病人的术后镇痛、炎症因子及早期情绪的影响。方法:选择90例拟行乳腺癌根治手术的病人,随机分为观察组和对照组,各45例。2组均采用全身麻醉,术毕静脉自控镇痛泵,观察组舒芬太尼2μg/kg+艾司氯胺酮0.5 mg/kg+阿扎司琼20 mg,对照组舒芬太尼2μg/kg+阿扎司琼20 mg。比较2组病人术后视觉模拟评分法(VAS)评分、阿森斯失眠量表(AIS)评分、焦虑自评量表(SAS)评分、抑郁自评量表(SDS)评分、不良反应发生率及血清肿瘤坏死因子α(TNF-α)、白细胞介素6(IL-6)水平。结果:观察组T_(1)(术后6 h)、T_(2)(术后24 h)、T_(3)(术后48 h)时VAS评分均低于对照组(P<0.05~P<0.01)。T_(0)(术前24 h)时2组病人TNF-α、IL-6水平差异均无统计学意义(P>0.05),T_(1)、T_(2)时观察组TNF-α和IL-6水平均明显低于对照组(P<0.01)。T_(0)时2组AIS、SAS及SDS评分差异均无统计学意义(P>0.05),T_(2)、T_(3)时观察组AIS、SAS及SDS评分均低于对照组(P<0.05~P<0.01)。观察组术后补救镇痛发生率低于对照组(P<0.05),头晕发生率高于对照组(P<0.05)。结论:艾司氯胺酮用于乳腺癌根治术病人的术后镇痛,可以增强术后镇痛效果,减轻机体术后的炎症反应,明显改善病人睡眠质量,减少焦虑及抑郁情绪,提高病人康复质量。
Objective:To investigate the effects of esketamine on the postoperative analgesia,inflammatory factors and early mood in patients with breast cancer.Methods:A total of 90 patients scheduled by radical mastectomy were randomly divided into the observation group and control group(45 cases in each group).Two groups were treated with general anesthesia,and the patient-controlled intravenous analgesia pump with 2μg/kg sufentanil,0.5 mg/kg esketamine combined with 20 mg azasetron and 2μg/kg sufentanil combined with 20 mg azasetron were implemented in the observation group and control group after operation,respectively.The visual analogue scale(VAS)score,Athens-insomnia scale(AIS)score,self-rating anxiety scale(SAS)score,self-rating depression scale(SDS)score,incidence rate of adverse reactions and serum levels of tumor necrosis factor-α(TNF-α)and interleukin-6(IL-6)were compared between two groups.Results:The VAS scores in observation group at T_(1)(after 6 h of operation),T_(2)(after 24 h of operation)and T_(3)(after 48 h of operation)time points were significantly lower those that in control group(P<0.05 to P<0.01).There was no statistical significance in the serum levels of TNF-α and IL-6 between two groups at T_(0)(before 24 h of operation)(P>0.05),and the levels of TNF-α and IL-6 in observation group were significantly lower than those in control group at T_(1) and T_(2)(P<0.05).The differences of the scores of AIS,SAS and SDS between two groups at T_(0) were not statistically significant(P>0.05),and the scores of AIS,SAS and SDS in observation group at T_(2) and T_(3) were significantly lower than those in control group(P<0.05 to P<0.01).The incidence rate of postoperative analgesic rescue in observation group was significantly lower than that in control group(P<0.05),and the incidence rate of swirl in observation group was significantly higher than that in control group(P<0.05).Conclusions:The application of esketamine in postoperative analgesia of patients treated with radical mastectomy can enhance the postoperative analgesia effects,reduce the postoperative inflammatory reaction,significantly improve the quality of sleep,reduce the anxiety and depression,and improve the quality of rehabilitation of patients.
作者
李菊
刘明红
石军
孙杰
LI Ju;LIU Ming-hong;SHI Jun;SUN Jie(Department of Anesthesiology,The First Affiliated Hospital of Anhui University of Science and Technology,Huainan Anhui 232000,China)
出处
《蚌埠医学院学报》
CAS
2022年第9期1188-1191,共4页
Journal of Bengbu Medical College
基金
中国红十字基金会医学赋能公益专项基金(2022446)。
关键词
术后镇痛
艾司氯胺酮
炎症细胞因子
失眠指数
焦虑
抑郁
postoperative analgesia
esketamine
inflammatory cytokine
insomnia index
anxiety
depression
