地佐辛用于剖宫产术对产后抑郁及术后镇痛的影响

Effect of Dezocine on Postpartum Depression and Postoperative Analgesia after Cesarean Section

目的:探讨地佐辛用于剖宫产产妇对产后抑郁的影响,观察地佐辛复合舒芬太尼用于剖宫产术后镇痛的效果。方法:将深圳市龙岗区妇幼保健院2017年9月至2018年3月收治的剖宫产产妇120例随机分为D组、N组两组,每组60例。术毕均采用自控镇痛泵(PCIA)镇痛,药物配方为舒芬太尼150μg溶于0.9%氯化钠注射液配成100 mL。D组在术毕即刻、12 h、24 h、36 h静脉推注地佐辛5 mg,N组在以上4个时间点静脉推注0.9%氯化钠注射液1 mL。比较两组术后6 h、12 h、24 h、36 h、48 h的视觉疼痛模拟评分(VAS)和PCIA中舒芬太尼使用剂量及患者的不良反应情况,以及爱丁堡产后抑郁量表(EPDS)评分与抑郁量表(SSDS)评分。结果:两组产妇VAS评分、EPDS评分、SDS评分比较,差异均无统计学意义(P> 0.05);D组产妇的PCIA舒芬太尼用量、恶心呕吐和皮肤瘙痒发生率明显低于N组产妇,差异均具有统计学意义(P <0.05),两组产妇术后尿潴留、呼吸抑制的发生几率比较,差异均无统计学意义(P> 0.05)。结论:地佐辛复合舒芬太尼静脉镇痛不能降低行剖宫产患者产后抑郁的发生;但地佐辛用于剖宫产术后镇痛可以降低PCIA中舒芬太尼药物的使用量,并且降低产妇恶心呕吐和皮肤瘙痒的发生率。

Objective To investigate the effect of dezocine on postpartum depression after cesarean section, and to observe the effect of dezocine combined with sufentanil on analgesia after cesarean section. Methods From September 2017 to March 2018, 120 patients undergoing cesarean section in Longgang maternal and child health hospital were selected and randomly divided into group D and group N, with 60 cases in each group. After Cesarean section, followed by patient controlled intravenous analgesia(PCIA) with sulfentanil 150 ug dissolved with normal saline into 100 mL. In group D, 5 mg of dezocine was injected intravenously immediately after operation and at 12, 24 and 36 hours after operation. Visual Analogue Score(VAS),total-dose of sufentanil and adverse reactions were recorded at 6,12,24,36 and 48 hours after operation, and Scores of Edinburgh postnatal depression scale(EPDS) and self-rating depression scale(SDS) were recorded. Results There were no significant differences in VAS scores, EPDS scores and SDS scores between the two groups(P > 0.05).The dosages of sufentanil in PCIA and the incidences of nausea and vomiting and pruritus in group D were signifi cantly lower than those in group N(P < 0.05). There were no signifi cant differences in the incidences of urinary retention and respiratory depression between the two groups(P > 0.05). Conclusion Dezocine combined with sufentanil in PCIA could not reduce the incidences of postpartum depression in patients undergoing cesarean section, but it could reduce the dosages of sufentanil in PCIA and the incidences of maternal nausea and vomiting and pruritus.