艾司氯胺酮对腰椎间盘突出病人术后抑郁情绪的影响

Effects of Esmolamine on Depression in Orthopedic Patients with Lumbar Disc Herniation

摘要: 目的：探讨艾司氯胺酮对骨科腰椎间盘突出病人术后抑郁情绪的影响。方法：60例患有腰椎间盘突出的病人，随机分为A组(艾司氯胺酮组)和B组(对照组)，每组30例。2组病人均于静吸复合全身麻醉下行腰椎间盘突出减压术，气管插管前A组病人静脉注射艾司氯胺酮0.5 mg/mg，B组病人静脉注射等剂量生理盐水。术后镇痛泵：A组为艾斯氯胺酮50 mg + 布托啡诺10 mg + 生理盐水至100 ml。B组为布托啡诺10 mg + 生理盐水至100 ml。主要结局指标：简易抑郁筛查量表评分(PHQ-9)评分。次要结局指标：围术期患者心率(heart rate, HR)和平均动脉压(mean artery pressure, MAP)、超敏CRP、围术期简易精神状态检查量表(MMSE)，术后不良反应发生率。结果：与B组相比，A组低血压、心动过缓发生率明显降低，差异均有统计学意义(P < 0.05)。A组MMSE评分较高，CRP水平、PHQ-9评分低，差异均有统计学意义(P < 0.05)。A组精神症状发生率较高，差异具有统计学意义(P < 0.05)，高血压、恶心呕吐及分泌物增多发生率无统计学差异(P > 0.05)。结论：艾司氯胺酮可维持血流动力学稳定，减轻认知功能损伤，增强镇痛效果，改善抑郁状态，改善病人生活质量。

Abstract: Objective: To investigate the effect of esmolamine on depression in patients with orthopedic lumbar disc herniation. Methods: Sixty patients with lumbar disc herniation were randomly divided into group A (esmolamine group) and group B (control group) with 30 cases in each group. Patients in both groups were treated with lumbar disc herniation decompression under intravenous inhalation combined with general anesthesia. Before endotracheal intubation, patients in group A were intra-venously injected with 0.5 mg ketamine, and patients in group B were injected with the same dose of normal saline. Postoperative analgesic pump: group A: esketamine 50 mg + butorphanol 10 mg + normal saline to 100 ml. Group B was treated with butorphanol 10 mg + saline to 100 ml. Main out-come measures: mini-Depression screening scale (PHQ-9) score. Secondary outcome indicators: perioperative heart rate (heart rate, HR) and mean arterial pressure (mean artery pressure, MAP), hypersensitive CRP, perioperative mini mental state examination scale (MMSE); the incidence of postoperative adverse reactions. Result: Compared with group B, the incidence of hypotension and bradycardia in group A was significantly lower than that in group B (P < 0.05). In group A, MMSE score was higher, CRP level and PHQ-9 score were lower, the difference was statistically significant. The incidence of mental symptoms in group A was significantly higher than that in group A (P < 0.05), but there was no significant difference in the incidence of hypertension, nausea and vomiting and increased secretion in group A (P > 0.05). Conclusion: Esmolamine can maintain hemodynamic stability, reduce cognitive impairment, enhance analgesic effect, improve depression and improve patients’ quality of life.