不同剂量艾司氯胺酮对中重度烧伤患者切痂植皮术后早期负面情绪的影响

Effects of Different Doses of Esketamine on the Early Negative Emotions of Patients with Moderate to Severe Burns after Eschericectomy and Skin Grafting

摘要: 目的：探讨不同剂量艾司氯胺酮对中重度烧伤患者切痂植皮术后早期负面情绪的影响。方法：选择拟在全身麻醉下行切痂植皮术的中度或重度烧伤患者，采用随机数字表法分为三组，各20例。高剂量组：静脉注射艾司氯胺酮0.5 ml/kg (浓度1 mg/ml)；低剂量组：静脉注射艾司氯胺酮0.5 ml/kg (浓度0.4 mg/ml)；空白对照组：静脉注射生理盐水0.5 ml/kg。收集患者术前一般临床资料，记录术中手术麻醉相关信息，术后48小时补救镇痛情况及相关不良反应。在术前及术后对患者分别进行焦虑(HADS-A)及抑郁(HADS-D)评估。结果：三组患者一般临床资料，麻醉时间、手术时间、输液量、术中血管活性药物的使用，以及术后不良反应情况的比较，差异均无统计学意义(P > 0.05)。与对照组和低剂量组比较，高剂量组患者术后48小时镇痛补救例数明显减少，差异有统计学意义(P < 0.05)。三组患者术前与术后HADS-A评分，以及两者差值的比较，差异均无统计学意义(P > 0.05)；三组患者术前与术后HADS-D评分的比较，差异均无统计学意义(P > 0.05)；与对照组相比，高剂量组患者术前与术后HADS-D差值明显增加，差异有统计学意义(P < 0.05)。结论：单次静脉输注艾司氯胺酮(0.5 mg/kg)，可有效缓解中重度烧伤患者切痂植皮术后早期抑郁情绪，并能减少患者术后48小时的镇痛补救例数。

Abstract: Objective: To explore the effects of different doses of esketamine on the early negative emotions of patients with moderate to severe burns after eschericectomy and skin grafting. Method: Patients with moderate or severe burns, who were scheduled to undergo eschericectomy and skin grafting under general anesthesia, were selected and divided into three groups using a random number table, with 20 cases in each group. The high-dose group received an intravenous dose of esketamine at 0.5 ml/kg with a concentration of 1 mg/ml. The low-dose group was given esketamine intravenously at 0.5 ml/kg with a concentration of 0.4 mg/ml. The control group received an intravenous injection of 0.5 ml/kg of normal saline. Patients’ general clinical information was gathered before the operation, intraoperative anesthesia details were noted, and the remedial analgesia and related adverse reactions within 48 hours after the operation were recorded. Patients were assessed for anxiety (HADS-A) and depression (HADS-D) both prior to and following the surgery. Result: There were no statistically significant differences in the general clinical data, anesthesia time, operation time, infusion volume, the use of vasoactive drugs during the operation, and postoperative adverse reactions among the three groups of patients (P > 0.05). Compared with the control group and the low-dose group, the number of cases of remedial analgesia within 48 hours after surgery in the high-dose group was significantly reduced (P < 0.05). There was no statistically significant difference in the HADS-A scores of among the three groups of patients before and after the operation, as well as the difference between them (P > 0.05). There was no statistically significant difference in the HADS-D scores among the three groups of patients before and after the operation (P > 0.05). Compared with the control group, the difference in HADS-D before and after the operation in the high-dose group was significantly increased (P < 0.05). Conclusion: Esketamine, when given as a single intravenous infusion at 0.5 mg/kg, can effectively alleviate early depressive symptoms in patients with moderate to severe burns following eschericectomy and skin grafting, and reduce the need for remedial analgesia within 48 hours after the operation.