【原】【罌粟摘要】?jī)?yōu)化艾司氯胺酮給藥治療術(shù)后抑郁癥：腹腔鏡減肥手術(shù)患者的綜合研究

罌粟花anesthGH 2024-12-26 發(fā)布于貴州

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優(yōu)化艾司氯胺酮給藥治療術(shù)后抑郁癥：腹腔鏡減肥手術(shù)患者的綜合研究

貴州醫(yī)科大學(xué) 麻醉與心臟電生理課題組

翻譯：王璐編輯：周倩審校：曹瑩

背景

先前的研究報(bào)告了關(guān)于艾司氯胺酮治療術(shù)后抑郁癥療效的發(fā)現(xiàn)。雖然亞麻醉劑量的艾氯胺酮對(duì)治療難治性抑郁癥有積極作用，但手術(shù)后抑郁癥患者對(duì)該藥物的反應(yīng)并不一致?；诼樽韺?duì)腦功能的影響，我們提出了一個(gè)假設(shè)，艾司氯胺酮給藥時(shí)間可能會(huì)顯著影響其治療術(shù)后抑郁癥的功效。本研究的目的是調(diào)查麻醉前后不同時(shí)間點(diǎn)服用艾司氯胺酮的效果。

方法

我們的隨機(jī)、雙盲、對(duì)照研究涉及 120 名接受腹腔鏡減肥手術(shù)的患者，隨機(jī)分為三組。Post-ESK組在麻醉誘導(dǎo)后接受靜脈注射艾司氯胺酮，劑量為0.2 mg/kg。Pre-ESK 組在麻醉誘導(dǎo)前 2 小時(shí)接受相同劑量的艾司氯胺酮。安慰劑組作為對(duì)照組，誘導(dǎo)后接受 0.9% 鹽水溶液。該研究的主要結(jié)果指標(biāo)是通過患者健康問卷 9 (PHQ-9) 測(cè)量的抑郁評(píng)分和血漿腦源性神經(jīng)營(yíng)養(yǎng)因子 (BDNF) 水平。

結(jié)果

術(shù)后第一天，Pre-ESK 組 PHQ-9 評(píng)分、術(shù)后抑郁發(fā)生率和嚴(yán)重程度均顯著低于 Post-ESK 組和安慰劑組（ P < 0.05）。此外，ESK前組血漿BDNF水平顯著高于ESK后組和安慰劑組（ P <0.05）。值得注意的是，PHQ-9 評(píng)分與血漿 BDNF 水平呈負(fù)相關(guān)。

結(jié)論

我們的研究支持亞麻醉劑量的艾氯胺酮有可能減輕腹腔鏡減肥手術(shù)后的術(shù)后抑郁癥狀，并且麻醉藥物對(duì)其療效有顯著影響。麻醉后使用亞麻醉劑量的艾氯胺酮并不能改善腹腔鏡減肥手術(shù)患者的術(shù)后抑郁癥狀，而麻醉前使用亞麻醉劑量的艾氯胺酮可以改善術(shù)后抑郁癥狀。

原始文獻(xiàn)：Dai J,Lu Y,Zou Z, et al. Optimizing esketamine administration for postoperative depression: a comprehensive study on laparoscopic bariatric surgery patients. Psychopharmacology (Berl). 2024;:. doi:10.1007/s00213-024-06673-y

Optimizing esketamine administration for postoperative depression: a comprehensive study on laparoscopic bariatric surgery patients

Abstract

BACKGROUND Previous studies have reported conflicting findings regarding the efficacy of esketamine in managing postoperative depression. While the positive effects of subanesthetic doses esketamine have been observed in treatment-resistant depression, the response to this medication in patients experiencing depression following surgery has not been consistent. Building upon the known impact of anesthesia on brain function, we have formulated a hypothesis suggesting that the timing of esketamine administration in relation to anesthesia may significantly affect its efficacy in managing postoperative depression. The aim of this study was to investigate the effect of esketamine administered at different time points before and after anesthesia.
METHODS Our randomized, double-blind, controlled study involved 120 patients undergoing laparoscopic bariatric surgery, randomly divided into three groups. Group Post- ESK received an intravenous injection of esketamine at a dose of 0.2 mg/kg after anesthesia induction. Group Pre- ESK received the same esketamine dosage 2 h prior to anesthesia induction. Group Placebo served as the control group and received a 0.9% saline solution after induction. The primary outcome measures of the study were depression scores as measured by Patient Health Questionnaire-9 (PHQ-9) and plasma brain-derived neurotrophic factor (BDNF) levels.
RESULTS On the first postoperative day, the PHQ-9 scores, incidence and severity of postoperative depression in the Pre-ESK group were significantly lower than those in the Post-ESK and placebo groups (P?<?0.05). Additionally, plasma BDNF levels in the Pre-ESK group were significantly higher than those in the Post-ESK and placebo groups (P?<?0.05). Notably, there was a negative correlation between PHQ-9 scores and plasma BDNF levels.
CONCLUSIONS Our study supports the potential for subanesthetic dose esketamine to alleviate postoperative depression symptoms following laparoscopic bariatric surgery, and anesthetic drugs have a significant effect on its efficacy. The use of subanesthetic dose esketamine after anesthesia does not improve postoperative depression symptoms in patients undergoing laparoscopic bariatric surgery, while the use of sub-anesthetic dose esketamine before anesthesia can improve postoperative depression symptoms.