目的:带状疱疹后遗神经痛(PHN)患者常表现出抑郁样症状,显著影响他们的生活质量。Esketamine,以其镇痛特性而闻名,也因其快速抗抑郁作用而被认可。然而,其在PHN治疗中的疗效有待进一步探索。本研究旨在评估艾氯胺酮静脉患者自控镇痛(PICA)对PHN患者抑郁情绪的影响。
方法:本回顾性研究分析了2021年6月至2023年3月在西南医科大学附属医院住院和治疗的PHN患者。根据患者的治疗方案将患者分为艾氯胺酮组(E组)和舒芬太尼组(S组)。主要结果包括疼痛数字评定量表(NRS),抑郁症患者健康问卷-9(PHQ-9),和焦虑广泛性焦虑障碍-7(GAD-7)评分测量治疗前,3天的时候,7天,1个月,2个月,治疗后3个月。
结果:共83例患者纳入分析。治疗前,疼痛NRS无统计学差异,两组患者抑郁PHQ-9、焦虑GAD-7评分比较(P>0.05)。与治疗前相比,两组治疗后各时间点疼痛NRS评分均显著降低(P<0.05),组间无差异(P>0.05)。治疗后3天和7天,E组抑郁PHQ-9评分明显低于S组(P<0.05)。但在1个月时没有观察到显著差异,2个月,3个月(P>0.05)。焦虑GAD-7评分在E组显著低于S组3天,治疗后7天(P<0.05),1个月时无统计学差异,2个月,治疗后3个月(P>0.05)。
结论:PICA联合艾氯胺酮和舒芬太尼对PHN患者疼痛的缓解效果相同。然而,PICA与艾氯胺酮特异性改善焦虑和抑郁症的早期症状。
OBJECTIVE: Patients with Postherpetic Neuralgia (PHN) often exhibit depressive-like symptoms, significantly impacting their quality of life. Esketamine, known for its analgesic properties, has also been recognized for its rapid antidepressant effects. However, its efficacy in the treatment of PHN requires further exploration. This study aims to evaluate the impact of intravenous patient-controlled analgesia(PICA) with esketamine on depressive mood in PHN patients.
METHODS: This retrospective study analyzed PHN patients hospitalized and treated at the affiliated hospital of Southwest Medical University from June 2021 to March 2023. Patients were divided into the esketamine group (E group) and the
sufentanil group (S group) based on their treatment regimens. Primary outcomes included pain numerical rating scale(NRS), depression patient health questionaire-9(PHQ-9), and anxiety generalized anxiety disorder-7(GAD-7) scores measured before treatment, and at 3 days, 7 days, 1 month, 2 months, and 3 months post-treatment.
RESULTS: A total of 83 patients were included in the analysis. Before treatment, there were no statistically significant differences in pain NRS, depression PHQ-9, and anxiety GAD-7 scores between the two groups (P > 0.05). Compared to before treatment, significant reductions in pain NRS scores were observed at all post-treatment time points in both groups (P < 0.05), with no differences between groups (P > 0.05). The E group exhibited significantly lower depression PHQ-9 scores than the S group at 3 days and 7 days post-treatment (P < 0.05), but no significant differences were observed at 1 month, 2 months, and 3 months (P > 0.05). Anxiety GAD-7 scores were significantly lower in the E group compared to the S group at 3 days, 7 days post-treatment (P < 0.05), with no statistical differences at 1 month, 2 months, and 3 months post-treatment (P > 0.05).
CONCLUSIONS: Both PICA with esketamine and
sufentanil alleviated pain equally in PHN patients. However, PICA with esketamine specifically improved early symptoms of anxiety and depression.