亚麻醉剂量右旋氯胺酮给药对乳腺癌患者术后抑郁和焦虑的影响

Effect of sub-anesthetic dose of S-ketamine on postoperative depression and anxiety in breast cancer patients

关键词:  右旋氯胺酮  亚麻醉剂量  乳腺癌  抑郁  焦虑

Key words:  S-ketamine  sub-anesthetic dose  breast cancer  depression  anxiety

摘要:

目的观察亚麻醉剂量右旋氯胺酮给药对乳腺癌患者术后抑郁和焦虑的影响。方法选择拟在全麻下行择期乳腺癌根治术的患者80例，年龄18～65岁，随机分为右旋氯胺酮组（SK组）和对照组（C组）。SK组在术前全麻诱导时给予右旋氯胺酮0.125 mg/kg，并在术后镇痛泵中加入0.125 mg/kg，48 h内泵入。C组在同时点静脉滴注等容量生理盐水。记录术前和术后2、7 d的汉密顿抑郁量表17项（HAMD-17）和贝克焦虑量表（BAI）评分。记录术前及术后2、7 d的血清胶质细胞源性神经营养因子（glial cell line-derived neurotrophic factor, GDNF）和5-羟色胺（5-HT）表达水平；记录拔管后1 h及术后24 h的VAS评分、Ramsay镇静评分以及其他不良反应发生情况。结果与C组相比较，术后2、7 d，SK组的HAMD-17和BAI评分显著降低（P<0.05），血清GDNF和5-HT的表达显著上调（P<0.05）。与C组同时点比较，SK组拔管后1 h和术后24 h的VAS评分显著降低（P<0.05）；术后Ramsay镇静评分以及其他术后不良反应发生情况差异无统计学意义（P＞0.05）。结论亚麻醉剂量右旋氯胺酮静脉给药能改善乳腺癌患者术后1周的抑郁和焦虑评分及提高苏醒质量，未增加其他不良反应。

Abstract:

ObjectiveTo investigate the effect of S-ketamine subanesthetic dosage on postoperative depression and anxiety in breast cancer patients. MethodsA total of 80 patients aged 18-65 years undergoing elective radical mastectomy for breast cancer under general anesthesia were randomly divided into S-ketamine group(SK group) and control group(C group) with 40 cases in each group. In the SK group, S-ketamine 0.125 mg/kg was given during the induction of general anesthesia before operation, and 0.125 mg/kg was added to the postoperative analgesic pump within 48 hours; in group C, an equal volume of normal saline was injected intravenously. The 17-item Hamilton Depression Rating Scale(HAMD-17) and Beck Anxiety Inventory(BAI) scores were recorded before and 2,7 days after operation. The serum glial cell line-derived neurotrophic factor(GDNF) and serotonin(5-HT) levels were measured before and 2, 7 days after the operation. The VAS score and Ramsay sedation score 1 h after extubation and 24 h after operation were documented; and the incidence of adverse reactions was observed. ResultsCompared with group C, the HAMD-17 and BAI scores of SK group 2 and 7 days after operation were significantly reduced(P<0.05), and serum GDNF and 5-HT levels were significantly increased at 2 and 7 days after operation(P<0.05). Compared with group C, the VAS scores of SK group 1 h and 24 h after extubation were significantly lower(P<0.05). There were no significant differences in Ramsay sedation scores and other postoperative adverse reactions after surgery between two groups. ConclusionIntravenous administration of sub-anesthetic dose of S-ketamine can improve postoperative depression and anxiety, and improve the quality of recovery in breast cancer patients after surgery without increasing other adverse reactions.