艾司氯胺酮术后自控镇痛泵对结直肠癌根治术后老年患者心理状态和早期认知功能的影响  

Efficacy of postoperative self-controlled analgesia pump with esketamine after colorectal cancer radical surgery on the psychological status and early cognitive function of elderly patients

作　　者：何含 汪辉德[1] 邬瑞刚 钟庆[1] HE Han;WANG Huide;WU Ruigang;ZHONG Qing(Department of Anesthesiology,Jianyang People's Hospital,Jianyang 641400,Sichuan Province,China)

机构地区：[1]简阳市人民医院麻醉科,四川简阳641400

出　　处：《中国药师》2024年第8期1368-1374,共7页China Pharmacist

基　　金：四川省医学科研课题计划项目(S20037)。

摘　　要：目的探讨含艾司氯胺酮(ESK)的术后自控镇痛泵对结直肠癌(CRC)根治术后老年患者心理状态和早期认知功能的影响。方法回顾性收集2021年1月至2024年1月简阳市人民医院CRC根治术后老年患者资料,根据自控镇痛泵内药物不同,分为对照组[仅使用舒芬太尼(FEN)]和联合组(FEN联合ESK)。比较两组患者治疗前后疼痛程度[视觉模拟量表(VAS)和自控镇痛泵按压次数]、心理状态[90项症状自评量表(SCL-90)]和早期认知功能[蒙特利尔认知评估量表(MoCA)]。观察并记录两组患者自控镇痛泵使用过程中不良反应情况,评估安全性。结果研究共纳入86例患者,对照组45例,联合组41例。术前1 h,两组患者VAS评分、各维度心理状态评分和MoCA评分差异无统计学意义(P>0.05)。术后1 h(T_(2))、术后12 h(T_(3))、术后24 h(T_(4))和术后72 h(T_(5)),联合组VAS评分均显著低于对照组(P<0.05),且联合组镇痛泵使用次数显著低于对照组(P<0.05)。使用镇痛泵72 h后,两组患者在躯体化评分、强迫症状评分、人际关系评分等心理状态评分较治疗前均显著下降,且联合组低于对照组(P<0.05)。镇痛泵使用期间,两组患者MoCA评分均显示出先下降后上升趋势(P<0.05),T_(4)和T_(5)时,联合组MoCA评分均显著高于对照组(P<0.05)。安全性方面,两组患者在消化道症状、心律失常、眩晕和嗜睡的发生率差异无统计学意义(P>0.05)。结论ESK术后自控镇痛泵可有效缓解CRC根治术后老年患者疼痛程度、心理状态和早期认知功能,且安全性较好。Objective To explore the effects of postoperative self-controlled analgesic pump containing esketamine(ESK)on psychological status and early cognitive function of elderly patients after radical surgery for colorectal cancer(CRC).Methods The data of elderly patients after radical CRC surgery in Jianyang People's Hospital were retrospectively collected from January 2021 to January 2024,and were divided into the control group[only using sufentanil(FEN)]and the combined group(FEN combined with ESK)according to the different medications in the self-controlled analgesic pump.The pain levels[visual analog scale(VAS)and the number of presses of the self-controlled analgesic pump],psychological state[90-item symptom self-assessment scale(SCL-90)],and early cognitive function[Montreal Cognitive Assessment Scale(MoCA)]before and after treatment were compared between the two groups.Adverse reactions during the use of self-controlled analgesic pumps were observed and recorded in both groups to assess the safety.Results A total of 86 patients were included in the study,with 45 in the control group and 41 in the combined group.At 1 h before the surgery,there was no statistically significant difference in the VAS scores,dimensional mental status scores and MoCA scores between the two groups(P>0.05).At 1 h(T_(2)),12 h(T_(3)),24 h(T_(4))and 72 h(T_(5))after the surgery,the VAS scores of the combined group were significantly lower than those of the control group(all P<0.05)and the times of using the analgesic pump in the combined group were significantly lower than those in the control group(P<0.05).After 72 h of using analgesic pumps,the psychological state scores of patients in both groups in terms of somatization scores,obsessive-compulsive symptom scores,and interpersonal relationship scores decreased significantly compared with the pre-treatment period,and the score of combined group was lower than that of the control group(P<0.05).During the use of analgesic pumps,the MoCA scores of patients in both groups showed a decreasing

关 键 词：艾司氯胺酮 舒芬太尼 自控镇痛泵 结直肠癌 心理状态 早期认知功能 

分 类 号：R614[医药卫生—麻醉学] R735.3[医药卫生—外科学]