术前遮眼训练联合艾司氯胺酮对白内障超声乳化手术患者术后抑郁情绪的影响  

Effect of preoperative eye-covering training combined with esketamine on postoperative depression in patients undergoing phacoemulsification cataract surgery

作　　者：田春林 田刚 李林[1] 邹学军 涂青梅[3] TIAN Chunlin;TIAN Gang;LI Lin;ZOU Xuejun;TU Qingmei(Research Center of Basic and Clinical Pathology,Department of Anesthesiology,Renhe Hospital Affiliated to China Three Gorges University,Yichang 443002,China)

机构地区：[1]三峡大学基础与临床病理学研究中心,三峡大学附属仁和医院麻醉科,湖北省宜昌市443002 [2]湖北医药学院附属人民医院麻醉科 [3]湖北医药学院附属太和医院药学部

出　　处：《临床麻醉学杂志》2025年第3期273-277,共5页Journal of Clinical Anesthesiology

基　　金：湖北省自然科学基金(2014CFC1150);三峡大学基础与临床病理学研究中心开放基金(RHKFBL2022-08)。

摘　　要：目的观察术前遮眼训练联合亚麻醉剂量艾司氯胺酮对白内障超声乳化手术患者术后抑郁情绪的影响。方法选择择期表面麻醉下行白内障超声乳化手术的患者86例,男42例,女44例,年龄40~70岁,BMI 18.5~30.0 kg/m^(2),ASAⅠ或Ⅱ级。采用随机数字表法将患者分为两组:遮眼训练联合艾司氯胺酮组(E组)和表面麻醉组(S组),每组43例。E组术前1 d进行30 min遮眼训练,S组不进行此项训练。术前10 min两组行表面麻醉。术前5 min E组静注艾司氯胺酮0.25 mg/kg,S组静注等容量生理盐水。记录术前1 d、术后1 d、术后1周抑郁评分。记录手术开始后5、10 min、术毕即刻HR、MAP、RR、SpO_(2)和NRS评分。记录术中使用乌拉地尔和追加表面麻醉情况。记录患者满意度、手术医师满意度。记录围术期不良事件的发生情况。结果与术前1 d比较,术后1 d S组抑郁评分明显升高(P<0.05)。与S组比较,术后1 d E组抑郁评分明显降低(P<0.05),手术开始后5 min至术毕即刻E组HR、MAP和NRS评分均明显降低(P<0.05),术中使用乌拉地尔和追加表面麻醉率明显降低(P<0.05),手术医师满意率明显升高(P<0.05)。手术开始后5 min至术毕即刻两组SpO_(2)、RR差异无统计学意义。两组均无不良事件发生。结论术前遮眼训练联合亚麻醉剂量艾司氯胺酮可在短期改善患者术后抑郁情绪,减轻疼痛,提高患者围术期舒适度。Objective To observe the impact of preoperative eye-covering training combined with sub-anesthetic dose of esketamine on postoperative depression in patients undergoing phacoemulsification cataract surgery.Methods A total of eighty-six patients undergoing phacoemulsification cataract surgery were selected,42 males and 44 females,aged 40-70 years,BMI 18.5-30.0 kg/m^(2),ASA physical statusⅠorⅡ.Patients were randomly divided into two groups using the random number table method:the eye-covering training combined with esketamine group(group E)and the surface anesthesia group(group S),43 patients in each group.In group E eye-covering training was performed for 30 minutes on 1 day before surgery,and group S did not undergo this training.Two groups of patients received surface anesthesia at 10 minutes before surgery.In group E was infused esketamine 0.25 mg/kg at 5 minutes before surgery,and in group S was given the same dose of saline intravenously.The depression scale scores were recorded on 1 day before surgery,the first day after surgery begin,and the first week after surgery.The HR,MAP,RR,SpO_(2),and NRS pain scale scores,were recorded at 5,10 minutes after surgery begin,and end of surgery.The incidences of urapidil administration and additional surface anesthesia were recorded.Patient satisfaction and surgeon satisfaction were recorded.Perioperative adverse events were recorded.Results Compared with 1 day before surgery,the depression score of group S was significantly increased 1 day after surgery(P<0.05).Compared with group S,depression score in group E was significantly decreased 1 day after operation(P<0.05),and HR,MAP,and NRS scores in group E were significantly decreased from 5 minutes after surgery to the end of surgery(P<0.05).Compared with group S,the rate of urapidil and additional surface anesthesia was significantly decreased in group E(P<0.05),and the satisfaction rate of surgeons increased significantly in group E(P<0.05).There was no significant difference in SpO_(2) and RR between the two groups

关 键 词：遮眼训练 艾司氯胺酮 白内障 抑郁 疼痛 

分 类 号：R61[医药卫生—外科学]