Effects Of Esketamine On Postoperative Depression In Patients Undergoing Thoracoscopic Lung Cancer Surgery

Objective The incidence of postoperative depression in patients with malignant tumor is high,which affects the prognosis.Esketamine has a rapid antidepressant effect,so this study aims to investigate the effect of esketamine on postoperative depression in patients undergoing thoracoscopic lung cancer surgery and its possible mechanism.METHODS Sixty patients undergoing thoracoscopic lung cancer surgery were randomly divided into two groups,30 patients in each group.The trial group was given 0.2mg·kg^-1of esketamine 10 minutes before anesthesia induction,and the control group was given the same volume of sodium chloride injection.Anesthesia induction and maintenance plans were the same in the two groups.Thirty minutes before the end of the operation,the trial group was given 0.2mg·kg^-1 intravenous injection of esketamine,and the control group was given 0.15·g·kg^-1 intravenous injection of sufentanil.The patients’cognitive function,pain and depression were evaluated with mini-mental state examination（MMSE）,visual analogue scale（VAS）and depression scale（SDS）1 day before operation（T₀）and 1,3,5 days after operation（T₅,T₆,T₇）,and the changes of inflammatory factors and lymphocyte related indicators in serum were detected.The heart rate,mean arterial pressure and arterial carbon dioxide partial pressure were recorded immediately before anesthesia induction（T₁）,immediately after endotracheal intubation（T₂）,immediately after operation（T₃）,and immediately after endotracheal extubation（T₄）。The operative time and intraoperative application of propofol,opioids and vasoactive drugs and intraoperative blood loss were recordedRESULTS There was no significant difference in heart rate,mean arterial pressure,arterial partial pressure of carbon dioxide between the two groups before anesthesia induction,after endotracheal intubation,at the beginning of surgery,and immediately after tracheal tube extraction（P>0.05）,and there was no significant difference in operation time and bleeding volume（P>0.05）.The dosage of propofol and remifentanil and the utilization rate of vasoactive drugs in the trial group were lower than that in the control group（P<0.05）.Compared with T₀,MMSE score at T₅-T₇was decreased（P<0.05）,the scores of VAS and SDS in the two groups increased after operation.The scores of VAS in the trial group at T₅ and T₆ were significantly lower than those in the control group（P<0.05）,and the scores of SDS in the trial group at T₅,T₆ and T₇ were significantly lower than those in the control group（P<0.05）.Compared with T₀,serum content of interleukin（IL）-6,tumor necrosis factor（TNF）-αand IL-10 increased significantly in both groups at T₅ and T₆（P<0.05）.Compared with the control group,serum content of IL-6 and TNF-αwas lower in the trial group and serum content of IL-10 was higher in the trial group at T₅,T₆ and T₇（P<0.05）.Compared with T₀,the levels of CD3⁺T cells,CD4⁺T cells,CD4⁺/CD8⁺ratio,B cells and NK cells in both groups at T₅ and T₆ were significantly lower（P<0.05）.Compared with the control group,the levels of CD3⁺T cells and CD4⁺T cells in the trial group at T₅ and T₆,CD4⁺/CD8⁺ratio at T₆ and T₇,B cells at T₇,and NK cells at T₅ and T₇ were significantly higher（P<0.05）.The level of CD8⁺T cells in the trial group at T₇ was significantly lower than that in the control group（P<0.05）.CONCLUSION Esketamine can reduce the degree of postoperative depression in patients undergoing thoracoscopic lung cancer surgery,and its mechanism may be related to inhibiting inflammatory response and improving immune function.