艾司氯胺酮对合并术前焦虑和认知功能下降妇科恶性肿瘤患者的影响

Effects of esketamine on postoperative anxiety and cognitive function in patients with gynecological malignant tumor

中文关键词: 妇科恶性肿瘤  焦虑  认知功能  艾司氯胺酮  炎性因子  神经损伤蛋白

英文关键词: Gynecological malignancy  Anxiety  Cognitive function  Esketamine  Inflammatory factors  Nerve injury protein

中文摘要:

      
目的： 探讨艾司氯胺酮对合并术前焦虑和认知功能下降的妇科恶性肿瘤患者术后焦虑及认知功能的影响。
方法： 选择择期行妇科恶性肿瘤切除术患者89例，年龄18～64岁，BMI 18～28 kg/m²，ASA Ⅱ或Ⅲ级，术前1 d医院焦虑抑郁量表（HADS）中焦虑亚量表评分≥8分且蒙特利尔认知评分量表（MoCA）<26分。采用随机数字表法将患者分为两组：艾司氯胺酮组（S组，n=45）和生理盐水组（C组，n=44）。S组麻醉诱导时静注艾司氯胺酮0.2 mg/kg，麻醉维持时泵注艾司氯胺酮0.25 mg·kg^-1·h^-1，术后使用艾司氯胺酮PCIA镇痛。C组在麻醉诱导、维持和PCIA镇痛时予以等容量的生理盐水，其余用药同S组。于术前1 d、术后1、3 d采用HADS及MoCA评估患者焦虑情绪和认知功能。检测术前1 d和术后3 d肿瘤坏死因子-α（TNF-α）、白细胞介素-6（IL-6）、S100钙结合蛋白（S100β）、脑源性神经营养因子（BDNF）浓度。记录术中瑞芬太尼用量、麻黄碱使用情况，入PACU后10 min的Ramsay镇静评分、拔管时间、术后48 h内PCIA总按压次数、有效按压次数、术后补救镇痛情况以及术后48 h内高血压、低血压、恶心呕吐、寒战、头晕和发热等不良反应发生情况。
结果： 与C组比较，S组术后1、3 d焦虑发生率明显降低、MoCA认知评分明显升高，TNF-α、IL-6、S100β浓度明显降低，BDNF浓度明显升高，术中瑞芬太尼用量明显减少，Ramsay镇静评分明显升高，术后48 h内PCIA总按压次数、有效按压次数明显减少，术后发热发生率明显降低（P<0.05）。两组麻黄碱使用率、拔管时间、术后补救镇痛率及术后48 h内高血压、低血压、恶心呕吐、寒战和头晕发生率差异无统计学意义。
结论： 艾司氯胺酮可降低炎性因子浓度，减轻神经损伤，缓解妇科恶性肿瘤患者焦虑状态及减轻认知功能损伤。

英文摘要:

      
Objective: To investigate the effect of esketamine on postoperative anxiety and cognitive function in gynecological malignant tumor patients with preoperative anxiety and cognitive decline.
Methods: Eighty-nine patients were selected for resection of gynecological malignant tumors, aged 18-64 years, BMI 18-28 kg/m², ASA physical status Ⅱ or Ⅲ, the hospital anxiety and depression scale (HADS) anxiety subscale score ≥ 8 points and montreal cognitive rating scale (MoCA) < 26 points 1 day before surgery. The patients were divided into two groups using the random number table method: the esketamine group (group S, n = 45) and the normal saline group (group C, n = 44). In group S, esketamine 0.2 mg/kg was injected intravenously during anesthesia induction, 0.25 mg·kg^-1·h^-1 was injected by pump during anesthesia maintenance, and esketamine 100 mg was used in the postoperative analgesic pump. Group C was given the same volume of normal saline during anesthesia induction, maintenance and PCIA analgesia, and other medications were the same as those in group S. HADS and MoCA were used to evaluate patients' anxiety and cognitive function 1 day before surgery and the 1 day and 3 days after surgery. The concentration of tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6), S100 calcium-binding protein (S100β), and brain-derived neurotrophic factor (BDNF) were detected 1 day before surgery and 3 days after surgery. The intraoperative dosage of remifentanil, ephedrine use rate, Ramsay sedation score 10 minutes after admission to PACU, extubation time,the number of total and effective compressions of PCIA within 48 hours after surgery, postoperative remedial analgesia, and the occurrence of adverse reactions, such as hypertension, hypotension, nausea and vomiting, chill, dizziness, and fever within 48 hours after surgerywere recorded.
Results: Compared with group C, the incidence of anxiety were significantly reduced and MoCA cognitive score were increased 1 day and 3 days after surgery, the concentrations of TNF-α, IL-6, and S100β were significantly reduced, the concentration of BDNF was significantly increased, the dosage of remifentanil was significantly reduced, the sedation score of Ramsay was significantly increased, the number of total compressions and effective compressions of PCIA within 48 hours after surgery was significantly reduced, and postoperative fever was significantly reduced in group S (P < 0.05). There were no statistically significant differences in ephedrine use rate, extubation time, postoperative remedial analgesia rate, the incidence of other adverse reactions, such as hypertension, hypotension, nausea and vomiting, chills and dizziness within 48 hours after surgery between the two groups.
Conclusion: Esketamine can decrease the concentrations of inflammatory factors and reduce nerve damage, help relieve anxiety and cognitive function of patients with gynecological malignant tumors.