艾司氯胺酮用于剖宫产术中对产妇RAAS系统、母婴安全及产后抑郁的影响  

Effects of esketamine use in cesarean section on maternal RAAS system,maternal and infant safety and postpartum depression

作　　者：薛萌 田卫国 XUE Meng;TIAN Weiguo(Department of Anesthesiology,Shaanxi Provincial Second People′s Hospital,Xi′an,Shaanxi 710003,China;Department of Anesthesiology,Affiliated Hanjiang Hospital,Xi′an Medical University,Xi′an,Shaanxi 723003,China)

机构地区：[1]陕西省第二人民医院麻醉科,陕西西安710003 [2]西安医学院附属汉江医院麻醉科,陕西西安723003

出　　处：《检验医学与临床》2023年第18期2706-2710,共5页Laboratory Medicine and Clinic

摘　　要：目的探讨艾司氯胺酮在剖宫产术中对产妇肾素-血管紧张素-醛固酮(RAAS)系统、母婴安全及产后抑郁的影响。方法从2020年1月至2022年8月陕西省第二人民医院接收的剖宫产产妇中随机选取220例,按照随机数字表法分为观察组和对照组,每组110例。所有产妇均行硬膜外麻醉,观察组产妇在胎儿取出后静脉注射艾司氯胺酮,对照组不做处理。对比两组产妇血清醛固酮(ALD)、血管紧张素Ⅱ(AT-Ⅱ)、肾素活性(PRA)水平,手术相关指标、恢复情况及首次喂养时间,产妇产后并发症及新生儿预后情况,同时采用40项术后恢复质量量表(QoR-40)、爱丁堡产后抑郁量表(EPDS)评估产妇的心理健康状况。结果两组产妇术中出血量、手术时间以及产后并发症总发生率比较,差异均无统计学意义(P>0.05)。两组新生儿娩出后1、5 min的Apgar评分及出生时体质量比较,差异均无统计学意义(P>0.05)。观察组产妇首次哺乳时间、住院时间以及首次下床时间均短于对照组(P<0.05),观察组新生儿出生1个月后的体质量高于对照组(P<0.05)。重复测量方差分析结果显示,PRA、AT-Ⅱ、ALD水平的变化存在时间效应、组间效应、交互效应(P<0.05)。产后1周,观察组QoR-40得分高于对照组,EPDS得分低于对照组,差异均有统计学意义(P<0.05)。结论艾司氯胺酮可有效维持产妇RAAS系统稳定,缓解产后抑郁,缩短其首次喂养时间以及住院时间,一定程度上有利于新生儿的生长发育,具有一定的安全性,值得在临床中推广。Objective To investigate the effects of esketamine in cesarean section on parturient renin-angiotensin-aldosterone(RAAS)system,maternal and infant safety and postpartum depression.Methods A total of 220 cases were randomly selected from the parturients receiving cesarean section in Shaanxi Provincial Second People′s Hospital from January 2020 to August 2022 and divided into the observation group and control group according to the random number table method,110 cases in each group.All parturients conducted the epidural anesthesia.The observation group was intravenously injected by esketamine after the fetus delivery,while the control group had no treatment.The levels of aldosterone(ALD),angiotensinⅡ(AT-Ⅱ),renin activity(PRA),the indexes related to operation,recovery and first feeding time,postoperative maternal complications and the neonatal prognosis were compared between the two groups,meanwhile the 40-item recovery quality scale(QoR-40)and the Edinburgh Postnatal Depression Scale(EPDS)were used to assess the mental health of the parturients.Results There was no statistically significant difference in the intraoperative bleeding amount,operative time and overall incidence rate of postpartum complications between the two groups(P>0.05).There was no statistically significant difference in the Apgar score at 1,5 min after delivery and the body mass at delivery between the two groups(P>0.05).The parturient first breastfeeding,hospitalization time and first time out of bed in the observation group were shorter than those in the control group(P<0.05),and the body mass of the newborns in 1 month after birth in the observation group was higher than that in the control group(P<0.05).The repeated measurement variance analysis results showed that there were statistically significant differences in time effect,inter-group effect and interaction effect of PRA,AT-Ⅱand ALD levels changes(P<0.05).The QoR-40 score at 1 week after delivery in the observation group was higher than that in the control group,the EPDS score w

关 键 词：剖宫产 艾司氯胺酮 肾素-血管紧张素-醛固酮系统 产后抑郁 母婴安全 

分 类 号：R614[医药卫生—麻醉学]