右美托咪定复合艾司氯胺酮治疗顽固性失眠伴抑郁症患者的有效性

Efficacy of dexmedetomidine combined with esketamine in the treatment of patients with intractable insomnia and depression

中文关键词: 右美托咪定  艾司氯胺酮  失眠  抑郁症  焦虑

英文关键词: Dexmedetomidine  Esketamine  Insomnia  Depression  Anxiety

中文摘要:

      
目的：评价右美托咪定复合艾司氯胺酮在顽固性失眠伴抑郁症中的临床疗效。
方法：选择顽固性失眠伴抑郁症患者68例，男26例，女42例，年龄18～64岁，BMI 18～28 kg/m²，ASA Ⅰ或Ⅱ级。将患者随机分为两组：右美托咪定复合艾司氯胺酮组（DE组）和右美托咪定复合生理盐水组（DS组），每组34例。两组分别用麻醉诱导睡眠平衡术治疗3个疗程，分别给予微泵注射右美托咪定1 μg/kg持续10 min以诱导睡眠，继以右美托咪定0.2～1.5 μg·kg^-1·h^-1维持睡眠。DE组同时泵注艾司氯胺酮0.5 mg/kg，DS组同时泵注生理盐水。分别在首次治疗前（T0）、第1疗程治疗后（T1）、第2疗程治疗后（T2）和第3疗程治疗后（T3）采取匹兹堡睡眠质量指数（PSQI）和失眠严重程度指数（ISI）评估睡眠状况，采取汉密尔顿抑郁量表（HAMD）和视觉模拟抑郁量表（VAS-D）评估抑郁状况，分析汉密尔顿焦虑量表（HAMA）和血清皮质醇浓度的变化。记录与T0比较，T3时的临床疗效评价和治疗期间呼吸抑制、恶心、呕吐、胸闷、心动过缓、低血压、焦虑、解离症状、木僵状态和噩梦等不良反应发生情况。
结果：与DS组比较，DE组T2、T3时PSQI和ISI评分均明显降低（P<0.05），T1、T2、T3时HAMD和VAS-D评分明显降低（P<0.05），T3时HAMA评分和血清皮质醇浓度明显降低（P<0.05），T3时总有效率明显升高（P<0.05）。两组不良反应发生率差异无统计学意义。
结论：右美托咪定复合艾司氯胺酮可明显改善顽固性失眠伴抑郁症患者的睡眠质量及抑郁焦虑症状，且无明显不良反应。

英文摘要:

      
Objective: To evaluate the clinical efficacy of dexmedetomidine combined with esketamine in the treatment of intractable insomnia with depression.
Methods: Sixty-eight patients, 26 males and 42 females, aged 18-64 years, BMI 18-28 kg/m², ASA physical status Ⅰ or Ⅱ, with intractable insomnia and depression were selected. The patients were randomly divided into two groups: dexmedetomidine combined with esketamine group (group DE) and dexmedetomidine combined with normal saline group (group DS), 34 patients in each group. All patients were treated with anesthesia-induced sleeping balance for three courses. The two groups were given dexmedetomidine 1 μg/kg by micro-pump injection for 10 minutes to induce sleep, followed by dexmedetomidine 0.2-1.5 μg·kg^-1·h^-1 to maintain sleep. Group DE was injected with esketamine 0.5 mg/kg and normal saline was injected simultaneously in group DS. Before pre-first treatment (T0), after the first course of treatment (T1), after the second course of treatment (T2) and after the third course of treatment (T3), the Pittsburgh sleep quality index (PSQI) and insomnia severity index (ISI) were used to evaluated sleeping quality, the Hamilton depression scale (HAMD) and the visual analogue scale for depression (VAS-D) were utilized to assess depression severity, the alternations of Hamilton anxiety scale (HAMA) and serum cortisol levels were also analyzed. The clinical efficacy evaluation at T3 compared with that at T0, and the occurrence of adverse reactions such as respiratory depression, nausea, vomiting, chest tightness, bradycardia, hypotension, anxiety, dissociation symptoms, stupor and nightmares were recorded during treatment.
Results: Compared with group DS, the PSQI and ISI scores were significantly decreased at T2 and T3 in group DE (P < 0.05), HAMD and VAS-D scores decreased significantly at T1, T2, and T3 (P < 0.05), HAMA score and serum cortisol concentration were significantly decreased at T3(P < 0.05), the total effective rate was significantly increased at T3(P < 0.05). There was no significant difference in the incidence of adverse effects between the two groups.
Conclusion: Dexmedetomidine combined with esketamine can significantly improve the sleeping quality, symptoms of depression and anxiety of patients with intractable insomnia and depression and there were no obviousadverse reactions.