舒芬太尼复合小剂量氯胺酮在剖宫产术后镇痛中的应用效果

Effect of sufentanil combined with low-dose ketamine applied to analgesia after cesarean section

目的探讨舒芬太尼复合小剂量氯胺酮在剖宫产术后镇痛中的应用效果。方法选择80例行经腹剖宫产术分娩的产妇,随机分为观察组和对照组,各40例。观察组术后给予舒芬太尼2μg/kg+氯胺酮2mg/kg+恩丹司琼8mg进行术后镇痛,对照组给予舒芬太尼3μg/kg+恩丹司琼8mg进行术后镇痛。采用疼痛视觉模拟量表(VAS)评分及Ramsay镇静评分评价两组产妇术后2h、4h、6h、12h、24h、48h的术口疼痛、宫缩疼痛及镇静程度,采用爱丁堡产后抑郁量表(EPDS)评价两组产妇产前及产后3d的抑郁情况,比较两组产妇镇痛期间的不良反应发生情况。结果两组术口VAS评分及Ramsay镇静评分比较,差异均无统计学意义(均P>0.05),但观察组宫缩VAS评分随时间上升的幅度低于对照组(P<0.05)。两组产妇镇痛期间不良反应发生率比较差异无统计学意义(P>0.05),但观察组产后EPDS评分低于对照组(P<0.05)。结论舒芬太尼复合小剂量氯胺酮用于剖宫产术后镇痛可有效缓解术后宫缩疼痛,减轻产后抑郁情绪,且不增加不良反应发生率。

Objective To explore the effect of sufentanil combined with low-dose ketamine applied to analgesia after cesarean section. Methods Eighty parturients undergoing transabdominal cesarean section were randomly divided into observation group and control group,with 40 cases in each group.The observation group was given sufentanil (2 μg/kg)+ketamine(2 mg/kg)+ondansetron(8 mg) for postoperative analgesia,while the control group was given sufentanil (3 μg/kg)+ondansetron(8 mg) for postoperative analgesia.Visual Analogue Scale(VAS) pain score and Ramsay sedation score were used to evaluate incision pain,contraction pain,and sedation level in the two groups 2,4,6,12,24 and 48 hours after operation,the Edinburgh Postnatal Depression Scale(EPDS) was used to evaluate parturients′ depression state in the two groups prenatally and 3 days postnatally,the incidence of adverse reactions of parturients were compared between the two groups. Results Incision VAS score or Ramsay sedation score showed no statistically significant differences between the two groups(all P >0.05),however,the observation group exhibited a minor time-dependent increment in VAS score for uterine contraction compared with the control group( P <0.05).There was no statistically significant difference in incidence rate of analgesia-emergent adverse reactions between the two groups( P >0.05),however,the observation group reported a lower prenatal EPDS score than the control group( P <0.05). Conclusion Sufentanil combined with low-dose ketamine can effectively relieve uterine contraction pain and alleviate postpartum depression after cesarean section,without increasing the incidence rate of adverse reactions.