艾司氯胺酮对口腔癌患者术后抑郁情绪的影响

Effect of esketamine on postoperative depression in patients with oral cancer

中文关键词: 艾司氯胺酮  口腔癌  游离皮瓣修复术  抑郁情绪  静脉给药  经鼻给药

英文关键词: Esketamine  Oral cancer  Free flap repair  Depression  Intravenous administration  Intranasal administration

中文摘要:

      
目的： 观察艾司氯胺酮对口腔癌患者术后抑郁情绪的影响，并探索安全有效的给药途径和给药剂量。
方法：选择择期行口腔癌切除术及游离皮瓣修复术的患者150例，男76例，女74例，年龄46～75岁，BMI≥16 kg/m² ，ASAⅠ—Ⅲ级。采用随机数字表法将患者分为五组：对照组（C组）、静脉注射艾司氯胺酮0.1 mg/kg组（Va组）、静脉注射艾司氯胺酮0.2 mg/kg组（Vb组）、经鼻给予艾司氯胺酮25 mg组（Na组）和经鼻给予艾司氯胺酮50 mg组（Nb组），每组30例。Va组、Vb组、Na组和Nb组于麻醉诱导后分别静脉注射或经鼻给予相应剂量艾司氯胺酮，C组经鼻给予等容量生理盐水1 ml。记录术前、术后第1天和术后第7天蒙哥马利抑郁评定量表（MADRS）评分、反应率、缓解率。记录术后48 h内镇痛泵有效按压次数和总按压次数。
结果：与C组比较，Vb组、Na组和Nb组术后第1天MADRS评分明显降低（P＜0.05），反应率和缓解率明显升高（P＜0.005）；Nb组术后第7天MADRS评分明显降低（P＜0.05），反应率和缓解率明显升高（P＜0.005）。与Nb组比较，Va组和Vb组术后第1天MADRS评分明显升高（P＜0.05）。与Va组比较，Nb组术后第1天反应率和缓解率明显升高，术后第7天缓解率明显升高（P＜0.005）。五组术后48 h内镇痛泵有效按压次数和总按压次数差异无统计学意义。
结论： 静脉注射和经鼻给予艾司氯胺酮均可改善口腔癌患者术后抑郁情绪，其中经鼻给予艾司氯胺酮50 mg能产生更有效且持久的抗抑郁作用。

英文摘要:

      
Objective: To observe the effect of esketamine on postoperative depression in patients with oral cancer and explore the safe and effective administration route and dose.
Methods: A total of 150 patients who underwent oral cancer resection and free flap repair were selected, 76 males and 74 females, aged 46-75 years, BMI ≥ 16 kg/m² , ASA physical status Ⅰ—Ⅲ. The patients were divided into five groups: control group (group C), intravenous esketamine 0.1 mg/kg group (group Va), intravenous esketamine 0.2 mg/kg group (group Vb), nasal esketamine 25 mg group (group Na), and nasal esketamine 50 mg group (group Nb) according to random number table method, 30 patients in each group. The group Va, group Vb, group Na and group Nb were given the corresponding dose of esketamine intravenously or nasal injection respectively after induction of anesthesia, and the group C was given 1 ml of normal saline with the same volume through the nose. Montgomery-asberg depression rating scale (MADRS) score, response rate and remission rate were recorded before surgery, the first day after surgery and the seventh day after surgery. The total number of effective analgesic pump compressions and total compressions within 48 hours after operation was recorded.
Results: Compared with group C, the MADRS score in groups Vb, Na and Nb on the first day after surgery were significantly lower (P < 0.05), and the response rate and remission rate were higher (P < 0.005), the MADRS score of group Nb was significantly decreased on the seventh day after surgery (P < 0.05), the response rate and remission rate were higher (P < 0.005). Compared with group Nb, the MADRS score in groups Va and Vb were significantly higher on the first day after surgery (P < 0.05). Compared with group Va, the response rate and remission rate of group Nb were significantly increased on the first day after surgery, and the remission rate was significantly increased on the seventh day after surgery (P < 0.005). There was no statistically significant difference in the effective and total press times of the analgesic pump within 48 hours after surgery between the five groups.
Conclusion: Both intravenous administration and intranasal administration of esketamine can improve postoperative depression in patients with oral cancer, and intranasal administration of 50 mg esketamine can produce more effective and long-lasting antidepressant effects.