多模式镇痛对剖宫产产妇术后镇痛效果及产后抑郁影响

Effects of Multimodal Analgesia on Postoperative Analgesia and Postpartum Depression in Parturients Undergoing Cesarean Section

目的探讨多模式镇痛对剖宫产产妇术后镇痛的效果及产后抑郁的影响。方法选择择期行剖宫产手术的单胎足月初产妇90例,根据镇痛方式不同将其分为观察组和对照组两组各45例,观察组采用硬膜外单次注射吗啡复合液10 ml+切口0.25%盐酸罗哌卡因局部浸润+静脉自控镇痛(patient controlled intravenous analgesia,PCIA)的多模式镇痛,对照组仅采用PCIA。比较两组术后6、12、24、48 h静息和运动视觉模拟评分法(visual analog scale, VAS)评分和改良Bromage评分,术后48 h镇痛效果满意度,术后72 h纯母乳喂养率,术前及术后24 h血糖和血乳酸水平,术前及术后1周爱丁堡产后抑郁量表(edinburgh postnatal depression scale, EPDS)评分及血清脑源性神经营养因子(brain derived neurotrophic factor, BDNF)水平,术后1周产后抑郁症(postpartum depression, PPD)发生率,以及术后48 h不良反应发生情况。结果术后6、12和24 h,观察组静息和运动VAS评分均低于对照组,差异有统计学意义(P<0.01)。术后6、12、24和48 h,两组改良Bromage评分均为0分。术后48 h,观察组镇痛效果满意度84.44%高于对照组镇痛效果满意度53.33%;术后72 h,观察组纯母乳喂养率66.67%高于对照组纯母乳喂养率42.22%,差异有统计学意义(P<0.05或P<0.01)。术前,两组血糖、血乳酸水平和EPDS评分、血清BDNF水平比较差异均无统计学意义(P>0.05)。术后24 h,两组血糖及血乳酸水平均较术前升高,且观察组血糖和血乳酸水平均低于对照组,差异有统计学意义(P<0.01)。术后1周,两组EPDS评分均较术前升高,血清BDNF水平均较术前降低;观察组EPDS评分低于对照组,血清BDNF水平高于对照组,差异有统计学意义(P<0.01)。术后1周,观察组PPD发生率6.67%低于对照组PPD发生率26.67%,差异有统计学意义(P<0.05)。术后48 h,两组总不良反应发生率比较差异无统计学意义(P>0.05)。结论剖宫产产妇采用多模式镇痛能增强术后镇痛效果,降低产后抑郁风险。

Objective To investigate the effects of multimodal analgesia on postoperative analgesia and postpartum depression(PPD) in parturients undergoing caesarean section(C-section). Methods Ninety single-term full-term primiparous women who underwent elective C-section were randomly divided into observation group(n=45) and control group(n=45), according to different analgesic methods. Both groups underwent C-section under combined spinal and epidural anaesthesia. The observation group was given multimodal analgesia, including a single epidural injection of Morphine compound solution 10 ml+local infiltration of 0.25% Ropivacaine Hydrochloride+patient controlled intravenous analgesia(PCIA), and the control group received PCIA alone. The resting and dynamic visual analog scale(VAS) scores and modified Bromage scores were compared at 6, 12, 24 and 48 h postoperatively between the two groups. The satisfaction of analgesic effects at 48 h after surgery and the exclusive breastfeeding rate at 72 h after surgery were compared. The blood glucose and blood lactate levels were compared before surgery and at 24 h after surgery. The Edinburgh postnatal depression scale(EPDS) score and serum brain-derived neurotrophic factor(BDNF) levels were compared before surgery and at 1 week after surgery. The incidence of PPD at 1 week after surgery and the occurrence of adverse reactions at 48 h after surgery were compared. Results The resting and dynamic VAS scores of the observation group at 6, 12 and 24 h after operation were significantly lower than those of the control group(P<0.01). Both groups had a modified Bromage scores of 0 at 6, 12, 24 and 48 h after surgery. The satisfaction rate of the analgesic effect in the observation group was 84.44%, which was higher than 53.33% in the control group at 48 h after surgery. The exclusive breastfeeding rate in the observation group was 66.67%, which was significantly higher than that in the control group(42.22%) at 72 h after surgery(P<0.05 or P<0.01). There were no significant differences in blood glucose, blood lactate levels, EPDS scores, and serum BDNF levels between the two groups before surgery(P>0.05). The blood glucose and blood lactic acid of the two groups at 24 h after surgery were higher than those before surgery, while the blood glucose and blood lactic acid levels of the observation group were significantly lower than those of the control group(P<0.01). At 1 week after surgery, the EPDS scores of the two groups were higher than those before surgery, and the serum BDNF levels were lower than those before surgery. The EPDS score of the observation group was lower than that of the control group, and the serum BDNF level was higher than that of the control group(P<0.01). The incidence of PPD at 1 week after surgery in the observation group was 6.67%, which was lower than 26.67% in the control group(P<0.05). There was no significant difference in the total incidence of adverse reactions between the two groups at 48 h after operation(P>0.05). Conclusion The use of multimodal analgesia for women undergoing C-section can enhance the analgesic effect and reduce the risk of PPD.