亚麻醉剂量艾司氯胺酮对腹腔镜结直肠癌根治术患者术后谵妄及负性情绪的影响  

Effect of sub-anesthetic dose of esketamine on postoperative delirium and negative emotions of patients undergoing laparoscopic radical resection for colorectal cancer

作　　者：张立媛 杨木强 司建洛[1] Zhang Liyuan;Yang Muqiang;Si Jianluo(Clinical Medical Collegeof Henan University of Science and Technology,Luoyang 471003,Henan,China)

机构地区：[1]河南科技大学临床医学院(河南科技大学第一附属医院),河南洛阳471003

出　　处：《临床心身疾病杂志》2024年第5期42-47,共6页Journal of Clinical Psychosomatic Diseases

基　　金：洛阳市医疗卫生指导性科技计划项目(编号2302014Y)。

摘　　要：目的探讨亚麻醉剂量艾司氯胺酮对腹腔镜结直肠癌根治术患者术后谵妄(POD)及负性情绪的影响。方法将110例腹腔镜结直肠癌根治术患者根据随机数字表法分为研究组和对照组,各55例。研究组患者静脉注射艾司氯胺酮和舒芬太尼,对照组患者静脉注射舒芬太尼。比较两组患者术前基本资料、手术及麻醉情况。采用ICU意识障碍评估法(CAM-ICU)和Richmond躁动-镇静量表(RASS)评估POD发生情况。采用汉密顿焦虑量表(HAMA)和汉密顿抑郁量表(HAMD)评估患者的焦虑、抑郁情况。记录并比较两组患者术后至首次下床活动时间、术后住院时间、患者及家属满意度评分。采用欧洲五维健康量表(EQ-5D)评估患者的术后生活质量,采用匹兹堡睡眠质量指数(PSQI)和阿森斯失眠量表(AIS)评估患者的睡眠状况。结果研究组患者POD发生率低于对照组(P<0.05)。术后7 d,两组患者HAMA和HAMD评分均较入院当天降低,且研究组低于对照组(P<0.01)。研究组患者术后至首次下床活动时间和术后住院时间均短于对照组,患者及家属满意度高于对照组(P<0.01)。术后研究组患者EQ-5D评分高于对照组,PSQI和AIS评分均低于对照组(P<0.01)。结论亚麻醉剂量艾司氯胺酮可降低腹腔镜结直肠癌根治术患者POD发生率,缓解负性情绪,促进术后康复。Objective To explore the effect of the sub-anesthetic dose of esketamine on postoperative delirium(POD)and negative emotions of patients undergoing laparoscopic radical resection of colorectal cancer.Methods A total of 110 patients undergoing laparoscopic radical surgery for colorectal cancer were divided into research and control group according to random number table,with 55 ones in each group.Research group received esketamine+sufentanil intravenously and controls did sufentanil.Preoperative basic information,operation and anesthesia of two groups were compared.POD occurrence was assessed using Confusion Assessment Method for the Intensive Care Unit(CAM-ICU)and Richmond Agitation-Sedation Scale(RASS).Patients'anxiety and depression were assessed using Hamilton Anxiety Scale(HAMA)and Hamilton Depression Scale(HAMD).First off-bed activity time,post-operative length of stay,patient and family satisfaction score of two groups were recorded and compared.Post-operative quality of life was assessed using the EuroQol Five-dimensional Questionnaire(EQ-5D)and sleeping status using Pittsburgh Sleep Quality Index(PSQI)and Athens Insomnia Scale(AIS).Results The incidence of POD was lower in research than control group(P<0.05).HAMA and HAMD scores on day 7 after operation in both groups were lower compared with the day of admission,so were those in research than control group(P<0.01).Time from postoperation to first time off-bed activity and post-operative length of stay were shorter,patient and family satisfaction higher in research than control group(P<0.01).EQ-5D score was higher and PSQI and AIS were lower in research than control group(P<0.01).Conclusion Sub-anesthetic dose of esketamine can reduce the incidence of POD in patients undergoing laparoscopic radical surgery for colorectal cancer,alleviate negative emotions,and promote postoperative rehabilitation.

关 键 词：艾司氯胺酮 术后谵妄 焦虑 抑郁 结直肠手术 肿瘤 

分 类 号：R619.7[医药卫生—外科学] R735.37[医药卫生—临床医学]