艾司氯胺酮复合羟考酮对剖宫产术后静脉自控镇痛及防治产后抑郁的效果

Effect of the combination of esketamine and oxycodone on patient-controlled intravenous analgesia and the prevention and treatment of postpartum depression after cesarean section

目的观察艾司氯胺酮复合羟考酮对剖宫产术后静脉自控镇痛及防治产后抑郁的效果。方法选取硬膜外麻醉下行剖宫产产妇80例,采用随机数字表法分为艾司氯胺酮复合羟考酮观察组(K组)和羟考酮对照组(C组),每组各40例。K组术后予艾司氯胺酮0.5 mg·kg^(-1)+羟考酮0.5mg·kg^(-1)+托烷司琼10mg+生理盐水至100mL;C组术后予羟考酮0.5mg·kg^(-1)+托烷司琼10mg+生理盐水至100 mL行静脉自控镇痛。背景输注剂量2 mL·h^(-1),自控给药量为5 m L,锁定时间为20 min,持续镇痛48 h。记录术后4 h、8h、12h、24h、48h的切口和宫缩视觉模拟疼痛评分法(VAS)疼痛评分以及Ramsay镇静评分(RSS)。观察2组术后不良事件发生情况以及产后2周、4周、6周抑郁发生情况。结果在各时间点,K组切口痛和宫缩痛的VAS评分均低于C组,差异有统计学意义(P<0.05);在各时间点,2组RSS评分差异无统计学意义(P>0.05),2组患者均未出现嗜睡和幻觉不良事件,在恶心呕吐和头昏方面2组相当,差异无统计学意义(P>0.05);K组在产后2周、4周、6周的爱丁堡产后抑郁量表(EPDS)的评分均低于C组,差异有统计学意义(P<0.05)。结论艾司氯胺酮复合羟考酮用于剖宫产术后静脉自控镇痛能有效减轻术后切口和宫缩疼痛,减轻产后抑郁症状,且不增加不良事件的发生率。

AIM To observe the effect of the combination of esketamine and oxycodone on patient-controlled intravenous analgesia and the prevention and treatment of postpartum depression after cesarean section.METHODS A total of 80 cases of cesarean section parturients under combined spinal and epidural anesthesia were randomly divided into the observation group(group K)of esketamine combined with oxycodone and the control group(group C)of oxycodone with 40 cases in each group.Postoperatively,group K was administered esketamine 0.5 mg·kg^(-1)+oxycodone 0.5 mg·kg^(-1)+tropisetron 10 mg+normal saline up to 100 mL.Group C received oxycodone 0.5 mg·kg^(-1)+tropisetron 10 mg+normal saline up to 100 mL for intravenous patient-controlled analgesia.The background infusion dose was 2 mL·h^(-1).The self controlled dosage is 5 mL,with the lockout time of 20 min,and continuous analgesia was maintained for 48 h.The visual analog scale(VAS)pain score and Ramsay sedation score(RSS)for incisional and uterine contraction pain were recorded at 4 h,8 h,12 h,24 h,and 48 h postoperatively.The incidence of adverse reactions and depression at 2,4 and 6 weeks after delivery were observed.RESULTS At each time point,the VAS scores for incision pain and uterine contraction pain in group K were lower than those in group C,showing a statistically significant difference(P<0.05).At each time point,the RSS scores of 2 groups were similar,with no statistically significant difference(P>0.05).There were no instances of drowsiness or hallucinations reported by patients in either group.Nausea,vomiting and dizziness were comparable between 2 groups,with no statistically significant difference(P>0.05).The scores on the Edinburgh Postnatal Depression Scale(EPDS)for group K at 2,4 and 6 weeks postoperatively were lower than those for group C,and the difference was statistically significant(P<0.05).CONCLUSION Esketamine combined with oxycodone for patient-controlled intravenous analgesia after cesarean section can effectively reduce the pain of incision and uterine contraction,relieve the symptoms of postpartum depression,and do not increase the incidence of adverse reactions.