艾司氯胺酮对剖宫产产妇术后镇痛及产后抑郁的影响  

Effect of esketamine on postoperative analgesia and postpartum depression in women undergoing caesarean section

作　　者：邵晓宇 梅欢[2] 杨进国 Shao Xiaoyu;Mei Huan;Yang Jinguo(Department of Anesthesiology,Graduate Training Base,Dongfeng General Hospital,Jinzhou Medical University,Shiyan 442000,China;Department of Anesthesiology,Dongfeng General Hospital Affiliated to Hubei University of Medicine,Shiyan 442000,China)

机构地区：[1]锦州医科大学国药东风总医院研究生培养基地麻醉科,十堰442000 [2]湖北医药学院附属国药东风总医院麻醉科,十堰442000

出　　处：《国际麻醉学与复苏杂志》2023年第2期160-164,共5页International Journal of Anesthesiology and Resuscitation

摘　　要：目的探讨艾司氯胺酮对剖宫产产妇术后镇痛及产后抑郁的影响。方法选取首次行剖宫产术的单胎、足月妊娠的产妇80例,按随机数字表法分为试验组和对照组,每组40例。两组产妇均进行腰硬联合麻醉(0.75%罗哌卡因2 ml),术后患者使用患者自控静脉镇痛(patient controlled intravenous analgesia,PCIA)。PCIA时对照组采用布托啡诺8 mg+生理盐水混匀稀释至100 ml,试验组采用艾司氯胺酮100 mg+布托啡诺8 mg+生理盐水混匀稀释至100 ml。记录两组产妇基线资料,术毕即刻(T_(0))、术后4 h(T_(1))、术后8 h(T_(2))、术后12 h(T_(3))、术后24 h(T_(4))、术后48 h(T_(5))的Ramsay镇静评分和VAS疼痛评分,T_(0)~T_(1)、T_(1)~T_(2)、T_(2)~T_(3)、T_(3)~T_(4)、T_(4)~T_(5)这5个时段PCIA按压次数,总按压次数,不良反应发生情况。采用爱丁堡产后抑郁量表(Edinburgh Postpartum Depression Scale,EPDS)和汉密尔顿抑郁量表(Hamilton Depression Scale,HAMD)评估两组产妇产后1周及产后6周时产后抑郁的发生情况。结果两组产妇各时点Ramsay镇静评分差异无统计学意义(P>0.05)。试验组T_(1)~T_(5)时VAS疼痛评分均低于对照组(P<0.05)。两组产妇T_(1)~T_(5)时VAS疼痛评分均高于T_(0)。T_(0)~T_(1)、T_(1)~T_(2)、T_(2)~T_(3)、T_(3)~T_(4)这4个时段内试验组PCIA按压次数少于对照组(P<0.05),T_(4)~T_(5)时段两组PCIA按压次数差异无统计学意义(P>0.05),两组PCIA总按压次数差异无统计学意义(P>0.05)。两组产妇不良反应发生情况差异无统计学意义(P>0.05)。产后1周试验组产后抑郁发生率低于对照组(P<0.05),产后6周两组产后抑郁发生率差异无统计学意义(P>0.05)。结论艾司氯胺酮用于剖宫产术后镇痛,不仅镇痛效果显著,还可降低术后早期产后抑郁的发生率。Objective To explore the effect of esketamine on postoperative analgesia and postpartum depression on women undergoing caesarean section.Methods A total of 80 parturients with single and full-term pregnancy who underwent the first cesarean section were selected.According to the random number table method,they were divided into two groups(n=40):a test group and a control group.Both groups underwent combined spinal epidural anesthesia(2 ml of 0.75%ropivacaine),followed by patient controlled intravenous analgesia(PCIA)after surgery.During PCIA,the control group was treated with 8 mg butorphanol diluted to 100 ml with normal saline,while the test group was treated with 100 mg esketamine+8 mg butorphanol diluted to 100 ml with normal saline.Then,the baseline data of the two groups were recorded.Their Ramsay sedation scores and Visual Analog Scale(VAS)scores were recorded immediately after operation(T_(0)),at postoperative 4 h(T_(1)),8 h(T_(2)),12 h(T_(3)),24 h(T_(4)),and 48 h(T_(5)).The PCIA pressing times and total pressing times during the intervals of T_(0)-T_(1),T_(1)-T_(2),T_(2)-T_(3),T_(3)-T_(4) and T_(4)-T_(5),as well as adverse reactions were recorded.Furthermore,Edinburgh Postpartum Depression Scale(EPDS)and Hamilton Depression Scale(HAMD)were used to assess the postpartum depression of both groups one and six weeks after delivery.Results There was no statistical difference in Ramsay sedation scores between the two groups at each time point(P>0.05).The test group showed lower VAS scores than the control group at T_(1)-T_(5)(P<0.05).Both groups presented higher VAS scores at T_(1)-T_(5) than those at T_(0).The test group showed decreases in PCIA pressing times during the intervals of T_(0)-T_(1),T_(1)-T_(2),T_(2)-T_(3),and T_(3)-T_(4),compared with the control group(P<0.05).There was no statistical difference in PCIA pressing times between the two groups during T_(4)-T_(5)(P>0.05).There was no statistical difference in total pressing times between the two groups(P>0.05).There was no statistical difference in a

关 键 词：艾司氯胺酮 产后抑郁 术后镇痛 

分 类 号：R614[医药卫生—麻醉学]