艾司氯胺酮对乳腺癌根治术患者术后焦虑抑郁及BDNF/ERK/Homer1a通路的影响  

Effects of Esketamine on Postoperative Anxiety, Depression and BDNF/ERK/Homer1a Pathway in Patients Undergoing Radical Mastectomy

作　　者：付成倩 黄青青 杨海红 曾镜铮 张杰[1] 巩固 Fu Chengqian;Huang Qingqing;Yang Haihong;Zeng Jingzheng;Zhang Jie;Gong Gu(North Sichuan Medical College,Nanchong 637000,China;Department of Anesthesiology,The General Hospital of Western Theater Command PLA,Chengdu 610083,China)

机构地区：[1]川北医学院,南充637000 [2]中国人民解放军西部战区总医院麻醉科,成都610083

出　　处：《成都医学院学报》2025年第2期221-224,240,共5页Journal of Chengdu Medical College

基　　金：国家自然科学基金项目(No:81902847)。

摘　　要：目的 探讨艾司氯胺酮对乳腺癌根治术患者术后焦虑、抑郁及脑源性神经营养因子(BDNF)/细胞外调节蛋白激酶(ERK)/Homer1a通路的影响。方法 选择某医院2024年3-7月全身麻醉下行乳腺癌根治术患者86例,采用随机数字法随机分为艾司氯胺酮组(B组)和生理盐水组(C组),每组43例。B组于麻醉诱导时予以0.2 mg/kg艾司氯胺酮,C组予以等量生理盐水,其余麻醉过程均一致,术后患者均使用自控静脉镇痛(PCIA)。于术前1 d(T0)、术后1 d(T2)、术后2 d(T3)、术后3 d(T4)进行医院抑郁-焦虑量表评分(HADS);于麻醉诱导前10 min(T1)、T2、T3、T4抽取静脉血3 mL,检测血清中Homer1a蛋白、BDNF、ERK1和ERK2含量;T2、T3、T4时使用视觉模拟评分法(VAS)评估术后疼痛程度;记录两组患者术后PCIA按压次数、PCIA首次按压时间及不良反应发生率。结果 与C组相比,B组T2、T3、T4时的HADS评分明显降低(P<0.05);血清中BDNF、ERK1、ERK2、Homer1a蛋白含量明显升高(P<0.05);B组T2的VAS评分、PCIA按压次数降低,PCIA首次按压时间延迟(P<0.05)。与同组T1比较,C组患者T2、T3、T4时的BDNF、ERK1、ERK2、Homer1a蛋白表达下调;B组患者T2、T3、T4时的BDNF和ERK1、T2和T4时的ERK2以及T2、T3时的Homer1a蛋白表达下调(P<0.05);两组患者术后不良反应发生率比较,差异无统计学意义(P> 0.05)。结论 麻醉诱导时静脉注射艾司氯胺酮可缓解乳腺癌根治术患者术后焦虑、抑郁症状,促进术后血清Homer1a蛋白、BDNF、ERK1、ERK2的表达,且未见明显不良反应。Objective To explore the effects of esketamine on postoperative anxiety,depression and brain-derived neurotrophic factor(BDNF)/extracellular regulated protein kinases(ERK)/Homer1a pathway in patients undergoing radical mastectomy.Methods A total of 86 patients scheduled for radical mastectomy under general anesthesia in a hospital from March 2024 to July 2024 were included.They were randomly allocated into two groups and were giving either intravenous infusion of 0.2 mg/kg esketamine(group B,n=43)or an equal amount of normal saline(group C,n=43)during anesthesia induction.The rest of the anesthesia induction steps were the same.Patient-controlled intravenous analgesia(PCIA)was used for postoperative analgesia.Hospital Anxiety and Depression Scale(HADS)was performed 1 d before operation(T0),1 d after operation(T2),2 d after operation(T3),and 3 d after operation(T4).Venous blood sample 3 mL was collected at four time points:10 min before anesthesia induction(T1),T2,T3 and T4.Serum levels of Homer1a protein,BDNF,ERK1 and ERK2 were measured.Postoperative pain was assessed by Visual Analogue Scale(VAS)for 3 consecutive days after the operation(T2,T3 and T4).The number of PCIA compressions,the time of the first PCIA compression,and the incidence of adverse reactions in both groups were recorded.Results Compared with group C,group B showed decreased HADS scores at T2,T3 and T4,increased serum levels of BDNF,ERK1,ERK2 and Homer1a proteins,decreased VAS score at T2,fewer PCIA compressions,and delayed first PCIA compression(P<0.05).In group C,serum BDNF,ERK1,ERK2 and Homer1a protein levels at T2,T3 and T4 were lower than those at T1(P<0.05).And in group B,BDNF and ERK1 at T2,T3 and T4,ERK2 at T2 and T4,and Homer1a protein expression at T2 and T3 were lower than those at T1(P<0.05).There was no significant difference in the incidence of postoperative adverse reactions between the two groups(P>0.05).Conclusion Intravenous esketamine during anesthesia induction relieves postoperative anxiety and depression,and promotes postop

关 键 词：艾司氯胺酮 术后抑郁 Homer1a蛋白 脑源性神经营养因子 细胞外调节蛋白激酶1/2 乳腺癌 

分 类 号：R614[医药卫生—麻醉学]