艾司氯胺酮对乳腺癌病人的术后镇痛、炎症因子及早期情绪的影响

目的探讨艾司氯胺酮对乳腺癌病人的术后镇痛、炎症因子及早期情绪的影响。方法选择90例拟行乳腺癌根治手术的病人，随机分为观察组和对照组，各45例。2组均采用全身麻醉，术毕静脉自控镇痛泵，观察组舒芬太尼2 μg/kg+艾司氯胺酮0.5 mg/kg+阿扎司琼20 mg，对照组舒芬太尼2 μg/kg+阿扎司琼20 mg。比较2组病人术后视觉模拟评分法(VAS)评分、阿森斯失眠量表(AIS)评分、焦虑自评量表(SAS)评分、抑郁自评量表(SDS)评分、不良反应发生率及血清肿瘤坏死因子α(TNF-α)、白细胞介素6(IL-6)水平。结果观察组T₁(术后6 h)、T₂(术后24 h)、T₃(术后48 h)时VAS评分均低于对照组(P < 0.05~P < 0.01)。T₀(术前24 h)时2组病人TNF-α、IL-6水平差异均无统计学意义(P>0.05)，T₁、T₂时观察组TNF-α和IL-6水平均明显低于对照组(P < 0.01)。T₀时2组AIS、SAS及SDS评分差异均无统计学意义(P>0.05)，T₂、T₃时观察组AIS、SAS及SDS评分均低于对照组(P < 0.05~P < 0.01)。观察组术后补救镇痛发生率低于对照组(P < 0.05)，头晕发生率高于对照组(P < 0.05)。结论艾司氯胺酮用于乳腺癌根治术病人的术后镇痛，可以增强术后镇痛效果，减轻机体术后的炎症反应, 明显改善病人睡眠质量，减少焦虑及抑郁情绪，提高病人康复质量。

Effect of the esketamine on postoperative analgesia,inflammatory factors and early mood in patients with breast cancer

ObjectiveTo investigate the effects of esketamine on the postoperative analgesia, inflammatory factors and early mood in patients with breast cancer.MethodsA total of 90 patients scheduled by radical mastectomy were randomly divided into the observation group and control group(45 cases in each group).Two groups were treated with general anesthesia, and the patient-controlled intravenous analgesia pump with 2 μg/kg sufentanil, 0.5 mg/kg esketamine combined with 20 mg azasetron and 2 μg/kg sufentanil combined with 20 mg azasetron were implemented in the observation group and control group after operation, respectively.The visual analogue scale(VAS) score, Athens-insomnia scale(AIS) score, self-rating anxiety scale(SAS) score, self-rating depression scale(SDS) score, incidence rate of adverse reactions and serum levels of tumor necrosis factor-α(TNF-α) and interleukin-6 (IL-6) were compared between two groups.ResultsThe VAS scores in observation group at T₁(after 6 h of operation), T₂(after 24 h of operation) and T₃(after 48 h of operation) time points were significantly lower those that in control group(P < 0.05 to P < 0.01).There was no statistical significance in the serum levels of TNF-α and IL-6 between two groups at T₀(before 24 h of operation)(P>0.05), and the levels of TNF-α and IL-6 in observation group were significantly lower than those in control group at T₁ and T₂(P < 0.05).The differences of the scores of AIS, SAS and SDS between two groups at T₀ were not statistically significant (P>0.05), and the scores of AIS, SAS and SDS in observation group at T₂ and T₃ were significantly lower than those in control group(P < 0.05 to P < 0.01).The incidence rate of postoperative analgesic rescue in observation group was significantly lower than that in control group(P < 0.05), and the incidence rate of swirl in observation group was significantly higher than that in control group(P < 0.05).ConclusionsThe application of esketamine in postoperative analgesia of patients treated with radical mastectomy can enhance the postoperative analgesia effects, reduce the postoperative inflammatory reaction, significantly improve the quality of sleep, reduce the anxiety and depression, and improve the quality of rehabilitation of patients.