艾司氯胺酮对乳腺癌患者术后早期精神状态的影响  

Effect of esketamine on early postoperative mental state in patients with breast cancer

作　　者：林小雷 马光泛 陈小珍 周森 LIN Xiaolei;MA Guangfan;CHEN Xiaozhen;ZHOU Sen(Department of Anesthesia Surgery,Wenzhou Hospital of Integrated Traditional Chinese and Western Medicine,Wenzhou 325000,Zhejiang,China)

机构地区：[1]温州市中西医结合医院麻醉手术科,浙江温州325000

出　　处：《中国现代医生》2025年第7期63-66,92,共5页China Modern Doctor

基　　金：浙江省温州市科研项目(Y2020786)。

摘　　要：目的探讨艾司氯胺酮对乳腺癌改良根治术患者术后早期精神状态的影响。方法选取2022年8月至2024年9月于温州市中西医结合医院接受乳腺癌改良根治术的95例乳腺癌患者,根据随机数字表法将患者分为对照组(48例)和实验组(47例)。两组患者均接受常规麻醉诱导超声引导下Ⅱ型胸神经阻滞。切皮前,实验组患者单次静脉注射艾司氯胺酮0.25mg/kg,对照组静脉注射等量生理盐水。比较两组患者的不良反应发生情况、视觉模拟评分法(visual analogue scale,VAS)评分、脑源性神经营养因子(brain-derived neurotrophic factor,BDNF)、肿瘤坏死因子-α(tumor necrosis factor-α,TNF-α)、白细胞介素-1β(interleukin-1β,IL-1β)、汉密尔顿抑郁量表(Hamilton depression scale,HAMD)评分、汉密尔顿焦虑量表(Hamilton anxiety scale,HAMA)评分、乳腺癌患者生命质量测定量表(functional assessment of cancer therapy-breast,FACT-B)评分。结果术后第1、3天,实验组患者的TNF-α、IL-1β水平及HAMA和HAMD评分显著低于对照组,BDNF水平显著高于对照组(P<0.05)。术后首次门诊时,实验组患者的FACT-B评分显著高于对照组(P<0.05)。术后第1天,两组患者的恶心呕吐、幻觉噩梦、躁动、嗜睡发生率和VAS评分比较差异均无统计学意义(P>0.05)。结论亚麻醉剂量的艾司氯胺酮联合Ⅱ型胸神经阻滞可改善乳腺癌改良根治术患者术后早期精神状态。Objective To explore the effect of esketamine on the early mental state of patients after modified radical mastectomy.Methods From August 2022 to September 2024,95 patients with breast cancer who received modified radical mastectomy in Wenzhou Hospital of Integrated Traditional Chinese and Western Medicine were selected and divided into control group(48 cases)and experimental group(47 cases)according to random number table method.Patients in both groups were routinely anesthetised and underwent typeⅡthoracic nerve block under ultrasound guidance.The experimental group was given a single intravenous injection of esketamine 0.25mg/kg before incision,while the control group was injected with the same amount of physiological saline.The incidence of adverse reactions,visual analogue scale(VAS)score,brain-derived neurotrophic factor(BDNF),tumor necrosis factor-α(TNF-α),interleukin-1β(IL-1β),Hamilton depression scale(HAMD)score,Hamilton anxiety scale(HAMA)score,functional assessment of cancer therapy-breast(FACT-B)score were all compared between two groups.Results On the 1st and 3rd day after surgery,the levels of TNF-αand IL-1β,the scores of HAMA and HAMD in experimental group were significantly lower than those in control group,and the level of BDNF was significantly higher than that in control group(P<0.05).The FACT-B score of experimental group was significantly higher than that of control group at the first clinic after surgery(P<0.05).On the first day after surgery,there were no significant differences in the incidence of nausea,vomiting,hallucination,nightmare,agitation,lethargy and VAS score between two groups(P>0.05).Conclusion The subanesthetic dose of esketamine combined with typeⅡthoracic nerve block can improve the early postoperative mental status of patients undergoing modified radical mastectomy.

关 键 词：艾司氯胺酮 Ⅱ型胸神经阻滞 乳腺癌改良根治术 焦虑 抑郁 不良反应 

分 类 号：R969.3[医药卫生—药理学]