【罂粟摘要】艾司氯胺酮对超声引导下行II型胸神经阻滞的改良根治性乳房切除术患者术后早期恢复质量的影响：一项随机对照试验

艾司氯胺酮对超声引导下行II型胸神经阻滞的改良根治性乳房切除术患者术后早期恢复质量的影响：一项随机对照试验

贵州医科大学      麻醉与心脏电生理课题组

翻 译：宋雨婷  编 辑：柏 雪  审 校：曹 莹

目的：评估艾司氯胺酮对超声引导下行II型胸神经阻滞（Pecs II阻滞）的改良根治性乳房切除术（MRM）的患者术后早期恢复质量的影响。

受试对象与方法：共纳入136例首次接受择期MRM治疗单侧乳腺癌（UBC）的女性患者，将其随机分为对照组（C组，n=68）和实验组（PE组，n=68）。舒芬太尼用于C组麻醉诱导和患者自控静脉镇痛（PCIA）。艾司氯胺酮用于PE组的麻醉诱导和PCIA。两组患者麻醉诱导后均行超声引导下Pecs II阻滞。所有其他的麻醉剂均以相同的方式给药。主要结局指标是出院时40项恢复质量（QoR-40）评分。次要结局指标是术后警觉/镇静（OAA/S）评分、麻醉恢复时间、数字评定量表（NRS）评分、血清炎性细胞因子白细胞介素-10（IL-10）、白细胞介素-6（IL-6）和白细胞介素-1ß（IL-1ß）、医院焦虑抑郁量表（HADS）评分、麻醉后恢复室（PACU）滞留时间、术后住院时间和患者满意度评分。

结果：与C组相比，PE组出院时QoR-40评分较高（P <0.05），术后24 h IL-6水平降低（P <0.05），焦虑抑郁评分较低（P <0.05），出院时患者满意度评分较高（P<0.05）。两组术后NRS评分、OAA/S评分、麻醉恢复时间、PACU滞留时间、住院时间无显著差异（P >0.05）。

结论：艾司氯胺可用于Pecs II阻滞的MRM患者的麻醉，从而提高患者术后早期恢复质量。

原始文献来源：Yu L, Zhou Q, Li W, et al. Effects of Esketamine Combined with Ultrasound-Guided Pectoral Nerve Block Type II on the Quality of Early Postoperative Recovery in Patients Undergoing a Modified Radical Mastectomy for Breast Cancer: A Randomized Controlled Trial. J Pain Res. 2022;15:3157-3169.

英文原文：

Effects of Esketamine Combined with Ultrasound-Guided Pectoral Nerve Block Type II on the Quality of Early Postoperative Recovery in Patients Undergoing a Modified Radical Mastectomy for Breast Cancer: A Randomized Controlled Trial

Abstract

Purpose To evaluate the effect of esketamine combined with ultrasound-guided pectoral nerve block type II (Pecs II block) on the quality of early postoperative recovery in patients undergoing a modified radical mastectomy (MRM) for breast cancer.

Patients and Methods A total of 136 female patients undergoing an elective MRM for unilateral breast cancer (UBC) for the first time were randomly divided into the control group (group C, n=68) and the experimental group (PE group, n=68). In group C, sufentanil was used for anesthesia induction and patient-controlled intravenous analgesia (PCIA). Esketamine was used for anesthesia induction and PCIA in the PE group. Ultrasound-guided Pecs II block was performed after anesthesia induction in the two groups. All other anesthetics were administered in the same way. The primary outcome was the 40-item Quality of Recovery (QoR-40) score at discharge. The secondary outcomes were postoperative Observer’s Assessment of Alertness/Sedation Scale (OAA/S) scores, time of anesthesia recovery, Numeric Rating Scale (NRS) scores, serum inflammatory cytokines interleukin-10 (IL-10), interleukin-6 (IL-6), and interleukin-1ß (IL-1ß), Hospital Anxiety and Depression Scale (HADS) scores, length of postoperative Postanesthesia Care Unit (PACU) stay, length of postoperative hospital stay and patient satisfaction score.

Results Compared with group C, the PE group had higher QoR-40 scores at discharge (P<0.05), decreased IL-6 levels at 24 h after surgery (P<0.05), lower anxiety and depression scores (P<0.05) and higher patient satisfaction scores at discharge (P<0.05). No significant difference was found in the NRS score postoperatively between the two groups (P>0.05). There was no significant difference in the postoperative OAA/S score, time of anesthesia recovery, length of postoperative PACU and hospital stays between the two groups (P>0.05).

Conclusion Esketamine combined with Pecs II block can be used for anesthesia in MRM for breast cancer, thus, improving patient quality of early postoperative recovery.

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