艾司氯胺酮对烧伤切削痂植皮患者术后焦虑和抑郁情绪的影响

目的： 探讨术中应用艾司氯胺酮对烧伤切削痂植皮患者术后焦虑和抑郁情绪的影响。
方法： 选择择期行烧伤切削痂植皮术患者73例，男46例，女27例，年龄18～64岁，BMI 18.5～27.9 kg/m²，ASA Ⅱ或Ⅲ级。采用随机数字表法将患者分为两组:艾司氯胺酮组（E组,n=37）和对照组（C组,n=36）。E组于麻醉诱导时静脉注射艾司氯胺酮0.2 mg/kg，并持续静脉泵注0.1 mg·kg^-1·h^-1至术毕；C组输注等容量生理盐水。两组术后行舒芬太尼患者自控静脉镇痛（PCIA）。记录术后睁眼时间、拔管时间、PACU停留时间、术后住院时间、术后镇痛泵有效按压次数、总按压次数和补救镇痛情况。记录术前1 d、术后3、7 d焦虑自评量表（SAS）、抑郁自评量表（SDS）评分和焦虑、抑郁的发生情况。记录术后48 h内不良反应的发生情况。
结果： 与C组比较，E组PACU停留时间和术后住院时间明显缩短（P＜0.05），术后镇痛泵有效按压次数、总按压次数明显减少（P＜0.05），补救镇痛发生率、术后3、7 d的SAS、SDS评分和焦虑、抑郁发生率明显降低（P＜0.05）。两组术后48 h内不良反应发生率差异均无统计学意义。
结论： 术中应用艾司氯胺酮能够改善烧伤切削痂植皮患者术后焦虑和抑郁情绪，减少术后阿片类药物用量，促进术后早期恢复。

Effects of esketamine on postoperative anxiety and depression in burn patients undergoing escharectomy and skin grafting

Objective: To investigate the effects of intraoperative application of esketamine on postoperative anxiety and depression in burn patients undergoing escharectomy and skin grafting.
Methods: Seventy-three patients undergoing escharectomy and skin grafting were selected, 46 males and 27 females, aged 18-64 years, BMI 18.5-27.9 kg/m², ASA physical status Ⅱ or Ⅲ. According to the random number table method, the patients were divided into two groups: esketamine group (group E, n = 37) and control group (group C, n = 36). Group E received a 0.2 mg/kg intravenous bolus of esketamine during anesthesia induction followed by a 0.1 mg·kg^-1·h^-1 continuous infusion until the end of surgery. Group C received an equal volume of normal saline. Patients in both groups received patient-controlled intravenous analgesia (PCIA) after surgery. The postoperative eye opening time, extubation time, PACU residence time, hospitalization and the number of effective compressions and total compressions of postoperative analgesia pumpand remediate analgesia after surgery were recorded. The self-rating anxiety scale (SAS), self-rating depression scale (SDS) and incidence of anxiety and depression were recorded 1 day before surgery, 3 and 7 days after surgery. The occurrence of adverse reactions within 48 hours after surgery were also recorded.
Results: Compared with group C, the postoperative PACU residence time and hospitalization in group E were shortened (P < 0.05), the times of effective and total compressions and remediate analgesia after surgery in group E were decreased (P < 0.05), the scores of SAS and SDS and incidence of anxiety and depression at 3 and 7 days after surgery in group E were decreased (P < 0.05). There were no statistical differences in adverse reactions within 48 hours after surgery between the two groups.
Conclusion: Intraoperative application of esketamine in burn patients undergoing escharectomy and skin grafting can improve postoperative anxiety and depression, reduce the usage of postoperative opioids and promote early recovery.