艾司氯胺酮对子宫切除术患者术后焦虑抑郁的影响

目的：观察艾司氯胺酮对子宫切除术后患者焦虑抑郁的影响。方法：选择全身麻醉下行腹腔镜子宫切除手术的患者160例。采用数字表法随机分为艾司氯胺酮组(E组)和对照组(C组)，每组80例。E组在手术切皮前5 min给予单剂量艾司氯胺酮0.4 mg·kg^-1(生理盐水稀释10 mg·mL^-1),C组在同样的时间输注等量的生理盐水。采用蒙哥马利-阿斯伯格抑郁量表(MADRS)、广泛性焦虑量表(GAD-7)对患者术前1天、术后第1天和第7天情绪进行评价。记录入室后5 min、插管即刻、切皮和拔管时的血压、心率，术中麻醉药物用量，术毕即刻、术后2 h和24 h视觉模拟评分(VAS)、舒适评分(BCS)及术后不良反应和住院时间。结果：和C组相比，E组术后24 h MARDS评分明显降低(P <0.05)。E组术后24 h MARDS评分> 11的人数显著少于C组(P <0.05)。两组术后24 h和7 d的GAD-7评分差异无统计学意义(P> 0.05)。E组术中瑞芬太尼用量低于C组，差异具有统计学意义。术后2 h的VAS评分E组低于C...

Effects of Esketamine on Postoperative Anxiety and Depression in Patients Undergoing Hysterectomy

Objective: To observe the effects of esketamine on anxiety and depression in patients after hysterectomy. Method: A total of 160 patients for laparoscopic hysterectomy under general anesthesia were randomly divided into group E and C by a digital table method, with 80 in each group. Patients in group E were given a single dose of esketamine (0.4 mg·kg-1, diluted with normal saline to 10 mg·mL-1) 5 min before surgical incision, and patients in group C were given the same dose of normal saline at the same time. The Montomery-Ashberg Depression Rating Scale(MARDS) and Generalized Anxiety Disorder7-item scale (GAD-7) were used to evaluate the mood of patients 1 day before surgery and 1 day and 7 days after surgery. The blood pressures and heart rates were recorded 5 minutes after entry, immediately after intubation, during skin incision and extubation. Data of intraoperative anesthetic dosage, visual analogue scale (VAS) and Bruggrmann comfort scale(BCS) immediately, 2 h and 24 h postoperative, postoperative adverse reactions and length of stay were recorded. Results: Compared with group C, MARDS scores of group E significantly decreased at 24 h after surgery (P < 0.05). The number of patients with postoperative MARDS >11 in group E was significantly less than that in group C (P < 0.05). There were no significant differences in GAD-7 scores at 1 d and 7 d after surgery between the two groups(P > 0.05). The intraoperative dosage of remifentanil in group E was significantly lower than that in group C (P < 0.05). The VAS score of group E was significantly lower than that of group C at 2 h after surgery (P < 0.05). There was no significant difference in postoperative adverse reactions between the two groups(P > 0.05). Conclusion: Esketamine at a subanesthetic dose before surgery can reduce the incidence and severity of depression on the first day after surgery, has a good analgesic effect in patients two hours after surgery and does not significantly increase postoperative adverse reactions, which is worthy of clinical promotion.