摘要
目的观察艾司氯胺酮对胸腔镜下乳腺癌根治术患者不良情绪及术后恢复情况的影响。方法该研究为前瞻性研究,选取2022年10月至2023年12月期间南阳医学高等专科学校第一附属医院接受胸腔镜下乳腺癌根治术治疗的96例患者为研究对象,应用电脑随机分组法将其分为全麻组(48例)和联合组(48例),全麻组予以常规全身麻醉,联合组采用艾司氯胺酮辅助全身麻醉,比较两组患者术后镇痛、镇静效果,麻醉恢复情况,神经递质水平,不良情绪评分。结果在不同麻醉方案下,联合组术后1 h、3 h的视觉模拟疼痛量表(VAS)评分分别为(2.33±0.25)分、(3.25±0.41)分,均低于全麻组[(3.25±0.36)分、(4.12±1.47)分](P<0.05);Ramsay镇静评分(RSS)分别为(3.77±0.27)分、(3.25±0.33)分,均高于全麻组[(3.12±0.36)分、(2.78±0.35)分](P<0.05)。联合组的术后睁眼时间、麻醉恢复室(PACU)停留时间分别为(11.17±2.36)min、(15.16±3.29)min,与全麻组[(10.83±2.41)min、(14.73±3.31)min]比较,差异无统计学意义(P>0.05);联合组的术后静脉自控镇痛(PCIA)泵应用时间、住院时间分别为(24.33±5.26)h、(8.45±1.21)d,均低于全麻组[(27.62±5.33)h、(10.29±2.36)d](P<0.05)。联合组术后24 h、48 h的谷氨酸(GLU)分别为(35.33±5.41)U/L、(40.49±5.28)U/L均高于全麻组[(32.25±5.36)U/L、(37.29±5.33)U/L](P<0.05);去甲肾上腺素(NE)分别为(55.39±10.22)μg/L、(70.23±10.42)μg/L均高于全麻组[(50.23±10.46)μg/L、(65.29±10.44)μg/L](P<0.05)。联合组术后48 h内的健康问卷抑郁症候群量表(PHQ-9)、广泛性焦虑量表(GAD-7)评分分别为(11.25±3.36)分、(13.51±3.18)分,均低于全麻组[(13.26±3.39)分、(15.54±3.75)分](P<0.05)。结论艾司氯胺酮辅助全身麻醉能增强乳腺癌根治术患者的术后镇痛、镇静效果,可下调神经递质水平并改善患者不良情绪。
【Objective】To observe the effect of esketamine on the bad mood and postoperative recovery of patients undergoing thoracoscopic radical breast cancer surgery.【Methods】This study is a prospective study.The subjects were 96 patients who received thoracoscopic radical surgery for breast cancer from October 2022 to December 2023 in the First Affiliated Hospital of Nanyang Medical College.They were divided into general anesthesia group(48 cases)and combined group(48 cases)by computer random grouping method.The general anesthesia group was given regular general anesthesia,and the combined group was assisted by esketamine general anesthesia.The postoperative analgesia and sedation effects,anesthesia recovery,neurotransmitter levels,adverse emotion scores of the two groups were compared.【Results】Under different anesthesia regimens,the Visual Analogue Scale(VAS)scores of the combined group at 1 hour and 3 hours postoperatively were 2.33±0.25 points and 3.25±0.41 points,lower than the general anesthesia group(3.25±0.36 points and 4.12±1.47 points)(t=14.543,3.950;P<0.05).The Ramsay Sedation Scale(RSS)scores were 3.77±0.27 points and 3.25±0.33 points,higher than the general anesthesia group(3.12±0.36 points and 2.78±0.35 points)(t=10.007,6.769;P<0.05).The postoperative eye opening time and post-anesthetic care unit(PACU)stay time of the combined group were 11.17±2.36 min and 15.16±3.29 min,similar to those in the general anesthesia group(10.83±2.41 min and 14.73±3.31 min)(t=0.698,0.638;P>0.05).The postoperative patient-controlled intravenous analgesia(PCIA)pump application time and hospital stay in the combination group were 24.33±5.26 h and 8.45±1.21 d,lower than the general anesthesia group(27.62±5.33 h and 10.29±2.36 d)(t=3.044,4.807;P<0.05).The glutamic acid(GLU)of the combined group at 24 and 48 hours after surgery were 35.33±5.41 U/L and 40.49±5.28 U/L,higher than the general anesthesia group(32.25±5.36 U/L and 37.29±5.33 U/L)(t=2.802,2.955;P<0.05).The norepinephrine(NE)were 55.39±10.22μg/L and 70.23±10.42μg/L,higher than the conventional group(50.23±10.46μg/L and 65.29±10.44μg/L)(t=2.445,2.320;P<0.05).The Patient Health Questionnaire-9(PHQ-9)and the Generalized Anxiety Disorder-7(GAD-7)scores within 48 hours after surgery in the combined group were 11.25±3.36 points and 13.51±3.18 points,lower than the general anesthesia group(13.26±3.39 points and 15.54±3.75 points)(t=2.918,2.860;P<0.05).【Conclusion】Esketamine assisted general anesthesia can enhance the postoperative analgesic and sedative effects of breast cancer patients undergoing radical surgery,and can lower the level of neurotransmitters and improve the patients'bad mood.
作者
曹鹏
白泉城
张凤君
CAO Peng;BAI Quancheng;ZHANG Fengjun(Department of Anesthesia,the First Affiliated Hospital of Nanyang Medical College,Nanyang,Henan 473000,China;Department of Anesthesia,the Obstetrics and Gynecology Hospital of Kaifeng,Kaifeng,Henan 475000,China)
出处
《中国医学工程》
2025年第4期58-62,共5页
China Medical Engineering
基金
河南省医学科技攻关项目(LHGJ20210162)。
关键词
乳腺癌根治术
全身麻醉
艾司氯胺酮
神经递质
不良情绪
radical mastectomy for breast cancer
general anesthesia
esketamine
neurotransmitters
negative emotions
