术中静脉滴注艾氯胺酮联合右美托咪定对乳房根治术患者术后睡眠障碍的影响。

IF 4.7 2区医学 Q1 CHEMISTRY, MEDICINAL

Drug Design, Development and Therapy Pub Date : 2025-05-31 eCollection Date: 2025-01-01 DOI:10.2147/DDDT.S510222

Xingyu Geng, Yutian Pu, Ziwei Hu, Heling Zhang, Maosan Wang, Can Fang, Gaochao Lv, Wanting Li, Xinyue Zhang, Xiaoxuan Fan, Su Liu, Xiuxia Chen, Jingru Wu

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引用次数: 0

摘要

目的：乳腺癌术后睡眠障碍（POSD）是乳腺癌患者术后普遍存在的问题。在相同情况下，艾氯胺酮联合右美托咪定治疗POSD的差异尚不清楚。我们研究术中艾氯胺酮联合静脉注射右美托咪定对POSD发生率和术后睡眠结构的影响。方法：采用单中心、随机、双盲对照试验。100例受试者随机分为4组：艾氯胺酮组（E组）、右美托咪定组（D组）、艾氯胺酮联合右美托咪定组（ED组）和对照组（S组），每组25例。持续注射干预药物直至置管。主要结局指标是POSD的发生率，定义为雅典失眠量表（AIS）在术后前三天至少有一天评分为bb0.6。次要结果测量是睡眠结构的持续时间，使用Fitbit Charge 2®智能手表（Fitbit, Inc.）收集。旧金山，加利福尼亚，美国)。结果：术后前3 d，四组间POSD发生率比较，差异无统计学意义（P=0.947）。然而，在术后第3天（POD3），艾氯胺酮和右美托咪定之间存在显著的相互作用（P=0.004）。进一步的简单效应分析显示，在不使用艾氯胺酮的情况下，右美托咪定对POSD对POD3有显著影响(OR=0.196, [0.056-0.691]；P = 0.019)。在不使用右美托咪定的情况下，艾氯胺酮对POD3的POSD有显著影响(OR=0.248, [0.074-0.833]；P = 0.042)。右美托咪定减少术后第1天快速眼动睡眠（REM）（P=0.042）。艾氯胺酮减少了POD1 （P=0.036）和POD3 （P=0.020）夜间觉醒时间。结论：术中输注艾氯胺酮联合右美托咪定对POSD无显著影响，但右美托咪定减少REM睡眠，艾氯胺酮减少夜间觉醒时间。

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Effect of Intraoperative Intravenous Infusion of Esketamine Combined with Dexmedetomidine on Postoperative Sleep Disturbance in Patients Undergoing Radical Mastectomy.

Objective: Postoperative sleep disturbance(POSD) is a problem in breast cancer patients after surgery. Little is known about the differences in the treatment of POSD with esketamine combined with dexmedetomidine under the same circumstances. We investigated the effects of intraoperative esketamine combined with intravenous dexmedetomidine on the incidence of POSD and postoperative sleep architecture.

Methods: A single-center, randomized, double-blind controlled trial was conducted. A total of 100 participants were randomly assigned to four groups: the esketamine group (Group E), the dexmedetomidine group (Group D), the esketamine combined with dexmedetomidine group (Group ED), and the control group (Group S) (n=25 each). The intervention drugs were continuously infused until the placement of the drainage tube. The primary outcome measure was the incidence of POSD, defined as an Athens Insomnia Scale (AIS) score >6 on at least one of the first three postoperative days. The secondary outcome measure was the duration of sleep structure, which was collected using the Fitbit Charge 2^® smartwatch (Fitbit, Inc. San Francisco, California, USA).

Results: In the first three postoperative days, the incidence of POSD was similar across the four groups (P=0.947). However, on postoperative day 3 (POD3), there was a significant interaction between esketamine and dexmedetomidine (P=0.004). Further simple effect analysis revealed that, in the absence of esketamine, dexmedetomidine had a significant effect on POSD on POD3 (OR=0.196, [0.056-0.691]; P=0.019). In the absence of dexmedetomidine, esketamine had a significant effect on POSD on POD3 (OR=0.248, [0.074-0.833]; P=0.042). Dexmedetomidine reduced rapid eye movement (REM) sleep on postoperative day 1 (P=0.042). Esketamine reduced nighttime awakening time on POD1 (P=0.036) and POD3 (P=0.020).

Conclusion: Intraoperative infusion of esketamine combined with dexmedetomidine had no significant effect on POSD, but dexmedetomidine reduced REM sleep, and esketamine reduced the nocturnal awakening time.

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来源期刊

Drug Design, Development and Therapy CHEMISTRY, MEDICINAL-PHARMACOLOGY & PHARMACY

CiteScore

9.00

自引率

0.00%

发文量

382

审稿时长

>12 weeks

期刊介绍： Drug Design, Development and Therapy is an international, peer-reviewed, open access journal that spans the spectrum of drug design, discovery and development through to clinical applications. The journal is characterized by the rapid reporting of high-quality original research, reviews, expert opinions, commentary and clinical studies in all therapeutic areas. Specific topics covered by the journal include: Drug target identification and validation Phenotypic screening and target deconvolution Biochemical analyses of drug targets and their pathways New methods or relevant applications in molecular/drug design and computer-aided drug discovery* Design, synthesis, and biological evaluation of novel biologically active compounds (including diagnostics or chemical probes) Structural or molecular biological studies elucidating molecular recognition processes Fragment-based drug discovery Pharmaceutical/red biotechnology Isolation, structural characterization, (bio)synthesis, bioengineering and pharmacological evaluation of natural products** Distribution, pharmacokinetics and metabolic transformations of drugs or biologically active compounds in drug development Drug delivery and formulation (design and characterization of dosage forms, release mechanisms and in vivo testing) Preclinical development studies Translational animal models Mechanisms of action and signalling pathways Toxicology Gene therapy, cell therapy and immunotherapy Personalized medicine and pharmacogenomics Clinical drug evaluation Patient safety and sustained use of medicines.