剖宫产术后两种不同药物静脉自控镇痛效果及对产后抑郁的影响  

Effect of the two different drugs for the patient-controlled intravenous analgesia of women after cesarean section and their influence on the postpartum depression of the women

作　　者：兰启琴 陈史伟 吴雯 陈永旺 LAN Qiqin;CHEN Shiwei;WU Wen;CHEN Yongwang(Xichang People's Hospital,Xichang,Sichuan Province,615000)

机构地区：[1]四川省西昌市人民医院,615000

出　　处：《中国计划生育学杂志》2025年第4期786-791,共6页Chinese Journal of Family Planning

基　　金：凉山州科技计划重点研发项目(23ZDYF0210);西昌市科技项目资助(ZDXM-2023-03)。

摘　　要：目的:探究艾司氯胺酮(esk)与右美托咪定(dex)静脉自控镇痛(PCIA)对剖宫产术(CS)后产妇抑郁情绪及疼痛的影响。方法:选取2022年5月-2024年4月在本院行CS的产妇175例,随机分为参照组(n=58)、esk组(n=59)和dex组(n=58),参照组CS术断脐后立即行PCIA(布托啡诺0.15mg/kg+阿扎司琼50ml+0.9%氯化钠注射液配成110ml,首剂2.5ml,维持2.8ml/h,追加2.0ml/次,锁定时间45min),esk组在参照组基础上给予esk(0.5 mg/kg)行PCIA,dex组在参照组基础上给予dex(0.5μg/kg)行PCIA。比较3组不同时间点疼痛视觉模拟评分(VAS)评分、Ramsay评分、产后抑郁量表(EPDS)评分及自控镇痛按压频次,记录头痛、恶心呕吐、呼吸抑制、头痛不良事件发生情况。结果:VAS评分、Ramsay评分、EPDS评分及自控镇痛泵按压频次在3组间均有差异;术毕各观察时点esk组、dex组VAS评分均低于参照组,Ramsay评分均高于参照组,且esk组VAS评分低于dex组、Ramsay评分高于dex组;术毕12 h、24 h、48 h自控镇痛泵按压频次esk组、dex组均低于参照组,且esk组少于dex组(均P<0.05);esk组、dex组头痛、恶心呕吐、呼吸抑制总计发生率(1.7%、6.9%)无差异但均低于参照组(17.2%)(P<0.05)。结论:CS后产妇采用esk行PCIA效果较dex更佳,可明显上调镇静、镇痛效用,缓解产后抑郁,未增加不良反应。Objective:To explore the influence of the patient-controlled intravenous analgesia(PCIA)with esketamine(esk)and dexmedetomidine(dex)of women after cesarean section(CS)on their depression and pain.Methods:175 pregnant women with CS in the hospital were selected and were randomly divided into three groups from May 2022 to April 2024.58 women in group C received PCIA(110ml analgesic medicine including 0.15mg/kg butorphanol,50ml azasetron and 0.9%sodium chloride injection,with the first dose of 2.5ml,the maintained dose of 2.8ml/h and the additional dose of 2.0 ml/time,and the locking time of 45min)immediately after cutting umbilical cord during CS,59 women in group A were given 0.5mg/kg esk for PCIA on the basis of that of the women in group C,and 58 women in group B were given 0.5μg/kg dex for PCIA on the basis of that of the women in group C.The scores of visual analogue scale(VAS),Ramsay and postpartum depression scale(EPDS)at different time points,and the compression frequency of the PCIA of the women were compared among the three groups.The adverse reactions,such as asheadache,nauseaand vomiting and respiratory depression,of the women in the three groups were recorded.Results:There were significant differences in the scores of VAS,Ramsay and EPDS,and the PCIA compression frequency of the women among the three groups.The VAS score of the women in group A or in group B at the different time point was significantly lower than that of the women in group C,and the Ramsay score of the women in group A or in group B at the different time point was significantly higher than that of the women in group C.The VAS score of the women in group A was significantly lower than that of the women in group B,and the Ramsay score of the women in group A was significantly higher than that of the women in group B.The pressing frequency of PCIA of the women in group A or in group B at 12h,24hor 48hafter operation was significantly lower than that of the women in group C,and which of the women in group A was significantly lower than t

关 键 词：剖宫产术 静脉自控镇痛 艾司氯胺酮 右美托咪定 产后抑郁 镇痛 

分 类 号：R614[医药卫生—麻醉学]