艾司氯胺酮对胸腔镜肺癌手术患者术后抑郁状态的影响  

Effects of esketamine on postoperative depression in patients undergoing thoracoscopic lung cancer surgery

作　　者：陈海涛 王先锋[2] 李伟[2] 王晓飞[2] 何淑芳[1] CHEN Hai-tao;WANG Xian-feng;LI Wei;WANG Xiao-fei;HE Shu-fang(Department of Anesthesiology and Perioperative Medicine,Second Affiliated Hospital of Anhui Medical University,Hefei ANHUI 230601,China;Department of Anesthesiology,Wanbei Coal-electricity Group General Hospital/Third Affiliated Hospital of Bengbu Medical College,Suzhou ANHUI 234001,China)

机构地区：[1]安徽医科大学第二附属医院麻醉与围术期医学科,安徽合肥230601 [2]皖北煤电集团总医院/蚌埠医学院第三附属医院麻醉科,安徽宿州234001

出　　处：《中国新药与临床杂志》2022年第12期743-747,共5页Chinese Journal of New Drugs and Clinical Remedies

基　　金：宿州市科技计划项目(SZSKJJZC2021044)。

摘　　要：目的探讨艾司氯胺酮对胸腔镜肺癌手术患者术后抑郁状态的影响。方法将择期行胸腔镜肺癌手术患者60例随机分为2组,每组30例。试验组于麻醉诱导前10 min给予艾司氯胺酮0.2 mg·kg^(-1),对照组则给予同体积的氯化钠注射液;2组麻醉诱导和维持方案相同,手术结束前30 min,试验组给予艾司氯胺酮0.2 mg·kg^(-1),对照组给予舒芬太尼0.15μg·kg^(-1)。监测患者心率、血压,并记录手术时间及术中出血量。于术前1 d(T_(0)),术后1、3、5 d(T_(1)、T_(2)、T_(3))采用视觉模拟评分量表(VAS)和抑郁评分量表(SDS)评估患者疼痛和抑郁情况,并取血检测血清炎症因子及淋巴细胞相关指标的变化。结果2组患者麻醉诱导前、气管插管后、手术开始、气管导管拔出即刻的心率、平均动脉压、动脉血二氧化碳分压比较均无显著差异(P>0.05),手术时间及出血量亦无显著差异(P>0.05)。与T_(0)比较,术后2组VAS和SDS评分均升高,T_(1)、T_(2)试验组VAS评分显著低于对照组(P<0.05),T_(1)、T_(2)、T_(3)试验组SDS评分显著低于对照组(P<0.05)。与T_(0)比较,T_(1)、T_(2)患者血清白细胞介素(IL)-6、肿瘤坏死因子(TNF)-α和IL-10含量均显著升高(P<0.05),T_(1)、T_(2)、T_(3)试验组IL-6、TNF-α水平显著低于对照组(P<0.05),IL-10水平显著高于对照组(P<0.05)。与T_(0)比较,T_(1)、T_(2)患者CD3^(+)、CD4^(+)T细胞水平、CD4^(+)/CD8^(+)比值、B细胞与NK细胞水平均显著降低(P<0.05);与同时点对照组比较,试验组T_(1)、T_(2)的CD3^(+)、CD4^(+)T细胞水平,T_(2)、T_(3)的CD4^(+)/CD8^(+)比值,T_(3)的B细胞水平和T_(1)、T_(3)的NK细胞水平均显著升高(P<0.05),T_(3)的CD8^(+)T细胞水平显著降低(P<0.05)。结论艾司氯胺酮可减轻胸腔镜肺癌手术患者术后抑郁状态的程度,机制可能与其抑制炎症反应、提高机体免疫功能有关。AIM To investigate the effects of esketamine on postoperative depression in patients undergoing thoracoscopic lung cancer surgery.METHODS Sixty patients undergoing thoracoscopic lung cancer surgery were randomly divided into two groups,30 patients in each group.The trial group was given 0.2 mg·kg^(-1) of esketamine 10 minutes before anesthesia induction,and the control group was given the same volume of sodium chloride injection.Anesthesia induction and maintenance plans were the same in the two groups.Thirty minutes before the end of the operation,the trial group was given 0.2 mg·kg^(-1) intravenous injection of esketamine,and the control group was given 0.15μg·kg^(-1) intravenous injection of sufentanil.The heart rate and blood pressure of the patients were monitored,and the operation time and intraoperative blood loss were recorded.The patients’pain and depression were evaluated with visual analogue scale(VAS)and depression scale(SDS)1 day before operation(T_(0))and 1,3,5 days after operation(T_(1),T_(2),T_(3)),and the changes of inflammatory factors and lymphocyte related indicators in serum were detected.RESULTS There was no significant difference in heart rate,mean arterial pressure,arterial partial pressure of carbon dioxide between the two groups before anesthesia induction,after endotracheal intubation,at the beginning of surgery,and immediately after tracheal tube extraction(P>0.05),and there was no significant difference in operation time and bleeding volume(P>0.05).Compared with T_(0),the scores of VAS and SDS in the two groups increased after operation.The scores of VAS at T_(1) and T_(2) in the trial group were significantly lower than those in the control group(P<0.05),and the scores of SDS at T_(1),T_(2) and T_(3) in the trial group were significantly lower than those in the control group(P<0.05).Compared with T_(0),serum content of interleukin(IL)-6,tumor necrosis factor(TNF)-α and IL-10 increased significantly at T_(1) and T_(2) in both groups(P<0.05).Compared with the control group,serum

关 键 词：艾司氯胺酮 肺肿瘤 抑郁 炎症 免疫 

分 类 号：R971[医药卫生—药品]