通讯作者: 周森, 21823398@qq.com

DOI：10.12201/bmr.202412.00054

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

• 摘要：目的 探讨艾司氯胺酮+II型胸神经阻滞应用于乳腺癌（breast cancer，BC）改良根治术病人早期精神状态的效果。方法 选取2022年08月至2024年09月温州市中西医结合医院接受BC改良根治术的100名患者开展研究，随机划分对照组（50人）、实验组（50人）。两组患者均常规麻醉诱导并在超声引导下行II型胸神经阻滞，实验组在切皮前单次给予静脉注射艾司氯胺酮0.25mg/kg，对照组注射等量生理盐水。记录两组患者一般情况及手术时长，术后第一天恶心呕吐、幻觉噩梦、躁动、嗜睡和疼痛视觉模拟量表 (visual analogue scale, VAS)评分。术前1d（T0）、术后第1d(T1)和术后第3d(T2)采集病人静脉血，用以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)和白细胞介素(interleukin, IL)-1β的测定，同时对患者开展汉密顿抑郁量表（hamilton depression scale，HAMD）、汉密顿焦虑量表（hamilton anxiety scale，HAMA）评估，并分析两组患者在术后首次门诊各亚组间乳腺癌患者生命质量测定量表(functional assessment of cancer therapy-breast, FACT-B)的差异。结果 与对照组比较，在T1、T2时间点TNF-α、IL-1β、HAMA和HAMD评分降低，BDNF水平升高（P＜0.05）；在FACT-B上，实验组相比于对照组，各亚组评分具有明显优势（P＜0.05）；两组患者VAS评分、恶心呕吐、幻觉噩梦、躁动和嗜睡情况无统计学意义（P＞0.05）。结论 应用亚麻醉剂量的艾司氯胺酮并联合II型胸神经阻滞可以改善乳腺癌患者术后的精神状况。

  关键词： 艾司氯胺酮; 乳腺癌改良根治术; 焦虑抑郁; 生活质量

   

  Abstract: Objective To observe the effect of esketamine combined with type II thoracic nerve block on early mental state of patients undergoing modified radical mastectomy. Methods 100 patients undergoing modified radical mastectomy were randomly divided into control group (50 patients) and experimental group (50 patients). Patients in both groups were routinely anesthetised and underwent type II thoracic 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 normal saline. The general condition and duration of operation, nausea and vomiting, hallucinations and nightmares, agitation, lethargy and VAS score on the first day after surgery were recorded in both groups. Venous blood was collected 1 day before surgery (T0), 1 day after surgery (T1) and 3 days after surgery (T2), and BDNF, TNF-α and IL-1β were measured. Meanwhile, HAMD and HAMA were evaluated. The difference of the FACT-B of breast cancer patients between the two groups at the first outpatient visit after surgery was analyzed. Results Compared with control group, the scores of TNF-α, IL-1β, HAMA and HAMD were decreased at T1 and T2 time points, and the level of BDNF was increased (P < 0.05). On FACT-B, the scores of the experimental group were significantly better than those of the control group (P < 0.05). VAS scores, nausea and vomiting, hallucinations and nightmares, agitation and lethargy were not statistically significant between the two groups (P > 0.05). Conclusion The subanesthetic dose of esketamine combined with nerve block can improve the postoperative mental status of breast cancer patients.

  Key words: Esketamine; Radical mastectomy; Anxiety and depression; Quality of life

  提交时间：2024-12-23

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• 序号	提交日期	编号	操作
  1	2024-11-23	bmr.202412.00054V1	下载

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