[1]陆化梅,于国军,郭永娟,等.艾司氯胺酮对良性骨肿瘤患者术后早期疼痛和认知功能的影响[J].新乡医学院学报,2021,38(6):516-519.[doi:10.7683/xxyxyxb.2021.06.004]
　LU Huamei,YU Guojun,GUO Yongjuan,et al.Effect of esketamine on early postoperative pain and cognitive function in patients with benign bone tumor[J].Journal of Xinxiang Medical University,2021,38(6):516-519.[doi:10.7683/xxyxyxb.2021.06.004]
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艾司氯胺酮对良性骨肿瘤患者术后早期疼痛和认知功能的影响
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《新乡医学院学报》[ISSN:1004-7239/CN:41-1186/R]

卷:
38
期数:
2021年6
页码:
516-519
栏目:
临床研究
出版日期:
2021-06-05

文章信息/Info

Title:
Effect of esketamine on early postoperative pain and cognitive function in patients with benign bone tumor
作者:
陆化梅1; 于国军1; 郭永娟1; 岳　辰2
（1.河南省洛阳正骨医院/河南省骨科医院麻醉科，河南　洛阳　471000；2.河南省洛阳正骨医院/河南省骨科医院髋部损伤中心，河南　洛阳　471000）
Author(s):
LU Huamei1; YU Guojun1; GUO Yongjuan1; YUE Chen2
（1.Department of Anesthesiology,Luoyang Orthopedic-traumatological Hospital of Henan Province,Henan Provincial Orthopedic Hospital,Luoyang 471000,Henan Province,China2.Hip Injury Center,Luoyang Orthopedic-traumatological Hospital of Henan Province,Henan Provincial Orthopedic Hospital,Luoyang 471000,Henan Province,China）
关键词:
艾司氯胺酮; 骨肿瘤; 术后疼痛; 认知功能
Keywords:
esketaminebone tumorpostoperative paincognitive function
分类号:
R614
DOI:
10.7683/xxyxyxb.2021.06.004
文献标志码:
A
摘要:
目的　探讨艾司氯胺酮对良性骨肿瘤患者术后早期疼痛及认知功能的影响。方法　选择2019年9月至2020年6月河南省洛阳正骨医院收治的68例良性骨肿瘤患者为研究对象，按随机数字表法将患者随机分为艾司氯胺酮组和对照组，每组34例。2组患者均于气管插管全身麻醉下行骨肿瘤切除内固定术，艾司氯胺酮组患者于气管插管后20 min静脉注射艾司氯胺酮0.5 mg·kg-1，对照组患者于气管插管后20 min静脉注射等量的生理盐水。记录2组患者术中出血量、麻醉时间和拔管时间；术后30 min及3、24 h，采用Ramsay镇静评分量表评估患者镇静效果；术后3、24、48 h，采用视觉模拟评分法（VAS）评估患者镇痛效果；记录2组患者术后48 h内补救镇痛例数；采用简易精神状态检查量表（MMSE）评估患者术前及术后12、24、36 h认知功能。结果　2组患者术中出血量、麻醉时间和拔管时间比较差异均无统计学意义（P＞0.05）。术后30 min和3 h，艾司氯胺酮组患者Ramsay镇静评分显著高于对照组（P＜0.05）；2组患者术后24 h时Ramsay镇静评分比较差异无统计学意义（P＞0.05）。术后3、24、48 h，艾司氯胺酮组患者VAS评分均显著低于对照组（P＜0.05）。术后48 h内，艾司氯胺酮组和对照组患者补救镇痛率分别为8.0%（3/34）、23.5%（8/34）；艾司氯胺酮组患者补救镇痛率显著低于对照组（χ2=11.342，P＜0.05）。2组患者术后12、24 h时MMSE评分显著低于术前（P＜0.05），2组患者术后36 h与术前MMSE评分比较差异无统计学意义（P＞0.05）；2组患者术前及术后36 h时MMSE评分比较差异无统计学意义（P＞0.05）；术后12、24 h，艾司氯胺酮组患者MMSE评分显著高于对照组（P＜0.05）。结论　术中应用小剂量艾司氯胺酮可以显著提高良性骨肿瘤患者术后早期镇痛和镇静效果，减轻患者术后短期内认知功能损伤。
Abstract:
Objective　To investigate the effect of esketamine on early postoperative pain and cognitive function in patients with benign bone tumors.Methods　　A total of 68 patients with benign bone tumor admitted to Luoyang Orthopedic-traumatological Hospital of Henan Province from September 2019 to June 2020 were selected as the research subjects.The patients were randomly divided into the esketamine group and the control group according to the random number table,with 34 cases in each group.The patients in the two groups were treated with endotracheal intubation and general anesthesia for bone tumor resection and internal fixation.The patients in the esketamine group received intravenous injection of 0.5 mg·kg-1 esketamine at 20 minutes after tracheal intubation,while the patients in the control group were injected with the same amount of normal saline at 20 minutes after tracheal intubation.The intraoperative bleeding volume,anesthesia time and extubation time of patients in the two groups were recorded.At 30 minutes,3 and 24 hours after operation,the sedation effect was evaluated by Ramsay sedation scale;at 3,24,4 h hours after operation,the analgesic effect was evaluated by visual analogue scale (VAS).The number of patients with remedial analgesia in the two groups was recorded within 48 hours after operation.The cognitive function was evaluated by the mini-mental state examination scale (MMSE) at before operation and 12,24,36 hours after operation.Results　There was no significant difference in intraoperative bleeding volume,anesthesia time and extubation time between the two groups (P>0.05).The Ramsay sedation score of patients in the esketamine group was significantly higher than that in the control group at 30 minutes and 3 hours after operation (P<0.05);there was no significant difference in Ramsay sedation score between the two groups at 24 hours after operation (P>0.05).The VAS score of patients in the esketamine group was significantly lower than that in the control group at 3,24 and 48 hours after operation (P<0.05).Within 48 hours after operation,the rescue analgesia rate of patients in the esketamine group and the control group was 8.0% (3/34) and 23.5% (8/34),respectively;the rescue analgesia rate in the esketamine group was significantly lower than that in the control group（χ2=11.342，P＜0.05）.The MMSE score of patients at 12 and 24 hours after operation were significantly lower than those before operation in the two groups (P<0.05).There was no significant difference in MMSE score between preoperation and 36 hours after operation in the two groups (P>0.05).There was no significant difference in MMSE score between the two groups preoperation and 36 hours after operation (P>0.05).The MMSE score of patients in the esketamine group was significantly higher than that in the control group at 12 and 24 hours after operation (P<0.05).Conclusion　The application of small dose of esmketamine during operation can significantly improve the early postoperative analgesia and sedation effect of patients with benign bone tumor,and reduce the short-term postoperative cognitive impairment.

参考文献/References:

［1］　TSUKAMOTO S,MAVROGENIS A F,LEONE G,et al.Denosumab does not decrease the risk of lung metastases from bone giant cell tumour［J］.Int Orthop,2019,43(2):483-489.
［2］　陈耀，赵紫健，许琦琦，等.术中输注小剂量氯胺酮对腹腔镜全子宫切除术患者术后疲劳的影响［J］.国际麻醉与复苏杂志，2020，41（5）：479-484.
［3］　陈自悦，肖玲，王惠玲，等.新型抗抑郁药氯胺酮的研究进展［J］.临床精神病医学杂志，2019，29（6）：426-430.
［4］　HIMMELSEHER S,DURIEUX M E.Ketamine for perioperative pain management［J］.Anesthesiology,2005,102(1):211-220.
［5］　STRICKLER E M,ACHWENK E S,COHEN M J,et al.Use of ketamine in a multimodal analgesia setting for rapid opioid tapering in a profoun dly opioid-tolerant patient：a case report［J］.A A Pract,2018,10 (7):179-181.
［6］　WANG J,HUANG J,YANG S,et al.Pharmacokinetics and safety of esketamine in Chinese patients undergoing painless gastroscopy in comparison with ketamine:a randomized,open-label clinical study［J］.Drug Des Devel Ther,2019,13:4135-4144.
［7］　KHAKPAI F,EBRAHIMI-GHIRI M,ALIJANPOUR S,et al.Ketamine-induced antidepressant like effects in mice:a possible involvement of cannabinoid system［J］.Biomed Pharmacother,2019,112:108717.
［8］　胡永冻，房捷欣.氯胺酮的抗抑郁作用［J］.中华精神科杂志，2015，48（1）：53-54.
［9］　王晓东，于明涛，刘子强，等.苯磺酸瑞马唑仑联合艾司氯胺酮静脉麻醉在内镜下逆行胰胆管造影术中的临床应用［J］.中国医刊，2021，56（3）：274-277.
［10］　张丽雷，徐梦晓，张静晓，等.艾司氯胺酮与N-甲基-D-天冬氨酸受体的分子作用机制［J］.山东化工，2020，49（8）：13-14，16.
［11］　向梅.艾司氯胺酮在无抽搐电休克治疗中的安全性及对抑郁症疗效的影响［J］.健康必读，2020（31）：84-85.
［12］　徐琛.LC-MS/MS同时测定全血中25种精神药物及乙醇对小鼠全血中氯胺酮浓度的影响［D］.杭州：浙江大学，2016.
［13］　赵文莉，邱妍，李玮玲，等.一种新机制抗抑郁药：艾司氯胺酮［J］.中国新药与临床杂志，2019，38（10）：585-588.
［14］　陈自悦，肖玲，王惠玲，等.新型抗抑郁药氯胺酮的研究进展［J］.临床精神医学杂志，2019，29（6）：426-428.
［15］　施于超，胡卫红.氯胺酮快速抗抑郁作用及机制研究［J］.神经疾病与精神卫生，2017,17（9）：654-657.
［16］　詹森药业有限公司.用于治疗抑郁症的方法：CN2015800 43454.X［P］.2017-05-24.

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更新日期/Last Update: 2021-06-05