Zhang Zhen, Zhang Wen-Hao, Lu Yin-Xiao, Lu Bo-Xuan, Wang Yi-Bo, Cui Li-Ying, Cheng Hao, Yuan Zhen-Yu, Zhang Jie, Gao Da-Peng, Gong Jian-Feng, Ji Qing
Department of Anesthesiology, Jinling Hospital, Medical School of Nanjing University, Nanjing 210016, China.
Department of General Surgery, Jinling Hospital, Medical School of Nanjing University, Nanjing 210016, China.
J Clin Med. 2023 Feb 1;12(3):1152. doi: 10.3390/jcm12031152.
Patients with Crohn's disease (CD) undergoing bowel resection often suffer from depression and acute pain, which severely impairs their recovery. We aimed to investigate the effects of S-ketamine preconditioning on postoperative depression in patients with CD undergoing a bowel resection with mild to moderate depression and to observe whether it can relieve postoperative pain and anti-inflammation. A total of 124 adult patients were randomized into one of the two groups. Patients in the S-ketamine group received a 0.25 mg/kg S-ketamine intravenous drip under general anesthesia induction, followed by a continuous infusion of S-ketamine with 0.12 mg/kg/h for more than 30 min through target-controlled infusion. Patients in the placebo group received 0.9% saline at an identical volume and rate. The primary outcome measure was the 17-item Hamilton depression Scale (HAMD-17). The secondary outcomes were scores on the following questionnaires: a nine-item patient health questionnaire (PHQ-9); a quality of recovery (QoR-15) form; and a numeric rating scale (NRS). Additional secondary outcomes included the levels of C-reactive protein (CRP) and interleukin 6 (IL-6) on postoperative days (PODs) 1, 3, and 5, the length of hospital stay, and opioid use throughout the hospital stay. The scores of PHQ-9 and HAMD-17 in the S-ketamine group were lower than those in the placebo group on postoperative days (PODs) 1, 2, and 7 ( < 0.05). The scores of QoR-15 in the S-ketamine group were higher than those in the placebo group on postoperative days (PODs) 3 and 5 ( < 0.05). The NRS scores of PACU, postoperative days 1 and 2 in the S-ketamine group were lower than those in the placebo group ( < 0.05). There was no significant difference in the CRP and IL-6 levels on postoperative days (PODs) 1, 3, and 5, postoperative complications, and hospital stay between the two groups ( > 0.05). The trial indicated that the intraoperative administration of low-dose S-ketamine could alleviate mild-to-moderate depressive symptoms and postoperative pain in patients with Crohn's disease undergoing bowel resection without worsening their safety.
接受肠道切除术的克罗恩病（CD）患者常伴有抑郁和急性疼痛，这严重影响了他们的康复。我们旨在研究S-氯胺酮预处理对接受肠道切除术且伴有轻至中度抑郁的CD患者术后抑郁的影响，并观察其是否能缓解术后疼痛和抗炎。总共124名成年患者被随机分为两组。S-氯胺酮组患者在全身麻醉诱导下静脉滴注0.25mg/kg S-氯胺酮，随后通过靶控输注以0.12mg/（kg·h）的速度持续输注S-氯胺酮超过30分钟。安慰剂组患者以相同的体积和速度输注0.9%生理盐水。主要观察指标是17项汉密尔顿抑郁量表（HAMD-17）。次要观察指标是以下问卷的得分：九项患者健康问卷（PHQ-9）；恢复质量（QoR-15）表；以及数字评分量表（NRS）。其他次要观察指标包括术后第1、3和5天的C反应蛋白（CRP）和白细胞介素6（IL-6）水平、住院时间以及住院期间的阿片类药物使用情况。S-氯胺酮组术后第1、2和7天的PHQ-9和HAMD-17得分低于安慰剂组（P<0.05）。S-氯胺酮组术后第3和5天的QoR-15得分高于安慰剂组（P<0.05）。S-氯胺酮组麻醉后恢复室（PACU）、术后第1和2天的NRS得分低于安慰剂组（P<0.05）。两组术后第1、3和5天的CRP和IL-6水平、术后并发症及住院时间无显著差异（P>0.05）。该试验表明，术中给予低剂量S-氯胺酮可减轻接受肠道切除术的克罗恩病患者的轻至中度抑郁症状和术后疼痛，且不会增加其安全性风险。
