艾司氯胺酮对乳腺癌患者围手术期的影响

义斌 王(承德医学院附属医院麻醉科，中国)
世宏 李()
庆宝 李(承德医学院附属医院麻醉科，中国)
德利 张(承德医学院附属医院麻醉科，中国)

摘要

目的：探讨艾司氯胺酮对乳腺癌患者围手术期的影响。方法：选择2021年12月至2022年6月于全麻下行单侧乳腺根治性切除术患者80例。随机分为两组，每组各40例。对照组和研究组在麻醉诱导后均给予0.5mg·kg-1艾司氯胺酮。术毕连接静脉自控镇痛泵（PCIA），对照组：舒芬太尼1ug·kg-1+布托啡诺0.1mg·kg-1+生理盐水稀释至100mL。研究组：舒芬太尼1ug·kg-1+布托啡诺0.1mg·kg-1+艾司氯胺酮0.5mg·kg-1+生理盐水稀释至100mL。比较两组术后1、3、5天视觉模拟评分（VAS）；术前1天、术后3天汉密尔顿抑郁量表（HAMD-17）评分。统计术后24小时PCIA自控次数，不良反应发生情况。结果：术后3天研究组HAMD评分明显低于对照组，差异均有统计学意义（P<0.05）。术后1天，研究组VAS评分明显低于对照组，差异有统计学意义（P>0.05）。两组PCIA自控次数和术后3天、术后7天VAS评分对比差异无统计学意义（P>0.05）。两组术后不良反应对比差异无统计学意义（P>0.05）。结论：术后持续泵注艾司氯胺酮可有效减少乳腺癌患者术后抑郁情绪，增强术后镇痛效果。

关键词

艾司氯胺酮；乳腺癌；抑郁；镇痛

参考

Howard F M, Olopade O I J T C J. Epidemiology of Triple-Negative

Breast Cancer: A Review [J]. The Cancer Journal, 2021, 27(1):8-16.

Lin H, Shi L, Zhang J, Et al. Epidemiological characteristics and

forecasting incidence for patients with breast cancer in Shantou,

Southern China: 2006-2017 [J]. Cancer Med, 2021, 10(8): 2904-13.

童静韬,王颖,倪平.乳腺癌患者术后肢体功能康复行为的质性研

究[J].中华护理杂志,2022, 57(6): 711-7.

Corriger A, Pickering G. Ketamine and depression: a narrative

review [J]. Drug Des Devel Ther, 2019(13):3051-3067.

Bahji A, Vazquez G H, Zarate C A, Jr. Comparative efficacy of

racemic ketamine and esketamine for depression: A systematic

review and meta-analysis [J].Affect Disord, 2021, (278):542-555.

Kim Y H, Choi K S, Han K, et al. A psychological intervention

programme for patients with breast cancer under chemotherapy and

at a high risk of depression: A randomised clinical trial [J]. Journal

of Clinical Nursing, 2018,27(3-4): 572-581.

Daly E J, Trivedi M H, JANIK A, et al. Efficacy of Esketamine Nasal

Spray Plus Oral Antidepressant Treatment for Relapse Prevention

in Patients With Treatment-Resistant Depression: A Randomized

Clinical Trial [J]. JAMA Psychiatry, 2019,76(9):893-903.

Deyama S, Duman R S. Neurotrophic mechanisms underlying

the rapid and sustained antidepressant actions of ketamine [J].

Pharmacol Biochem Behav, 2020(188):172837.

Reinert J, Parmentier B L. Effect of Perioperative Ketamine on

Postoperative Mood and Depression: A Review of the Literature [J].

Expert Rev Clin Pharmacol, 2021,14(1):25-32.

Bi Y, Ye Y, Zhu Y, et al. The Effect of Ketamine on Acute

and Chronic Wound Pain in Patients Undergoing Breast

Surgery: A Meta-Analysis and Systematic Review [J].Pain

Pract,2021,21(3):316-332.

Wei Y, Chang L, Hashimoto K. Molecular mechanisms underlying

the antidepressant actions of arketamine: beyond the NMDA

receptor [J]. Mol Psychiatry,2022,27(1):559-573.

Wang J, Wang Y, Xu X, et al. Use of Various Doses of S-Ketamine

in Treatment of Depression and Pain in Cervical Carcinoma

Patients with Mild/Moderate Depression After Laparoscopic Total

Hysterectomy [J]. Med Sci Monit, 2020, 26:e922028.

Lee C, Lee J, Lee G, et al. The effects of a combination of

intravenous dexamethasone and ketamine on postoperative mood in

patients undergoing laparoscopically assisted-gynecologic surgery

[J]. Psychopharmacology (Berl), 2018,235(8):2417-2422.

高长胜,黄符香,宋歌.艾司氯胺酮对高龄产妇剖宫产术后抑郁和

恢复质量的影响[J].中国新药与临床杂志,2022,41(9):535-539.

林贵文,胡青林,杨志来.艾司氯胺酮复合布托啡诺对剖宫产术后镇痛效果及产后状态的影响[J].中国计划生育学杂志,2022,30(5):1050-1054.

Wang X, Lin C, Lan L, et al. Perioperative intravenous S-ketamine

for acute postoperative pain in adults: A systematic review and

meta-analysis [J].Clin Anesth,2021(68):110071.

Kamp J, Jonkman K, Van Velzen M, et al. Pharmacokinetics

of ketamine and its major metabolites norketamine,

hydroxynorketamine, and dehydronorketamine: a model-based

analysis [J]. Br J Anaesth,2020,125(5):750-761.

DOI: http://dx.doi.org/10.12345/yzlcyxzz.v5i9.11994