地佐辛联合舒芬太尼对剖宫产后镇痛效果及产后抑郁的影响

Influence on Dezocine combined with Sufentanil on postpartum analgesia effect and postpartum depression after cesarean section

目的探讨地佐辛联合舒芬太尼对剖宫产后镇痛效果及产后抑郁的影响。方法选取2019年7月—2020年6月在深圳市龙岗区妇幼保健院行剖宫产术的120例产妇,按照双盲随机试验设计分为观察组和对照组,每组各60例。术毕,两组产妇均使用镇痛泵,其中观察组使用地佐辛联合舒芬太尼进行镇痛,对照组单纯使用舒芬太尼镇痛。采用视觉模拟评分法(VAS)和Ramsay镇静评分评价两组产妇的术后镇痛及镇静情况;统计两组产妇的不良反应发生率;采用爱丁堡妊娠后抑郁量表(EPDS)对两组产妇的抑郁状态评分进行评价。结果观察组产妇术后24 h的VAS疼痛评分高于术后12 h,差异有统计学意义(P<0.05);术后36 h,观察组产妇的VAS疼痛评分与术后12 h比较,差异无统计学意义(P>0.05);对照组产妇术后36 h的VAS疼痛评分低于术后12 h,差异有统计学意义(P<0.05);术后24 h,对照组产妇的VAS疼痛评分与术后12 h比较,差异无统计学意义(P>0.05);观察组产妇术后12、24、36 h的VAS疼痛评分均低于对照组,差异均有统计学意义(P<0.05)。术后24、36 h,两组产妇的Ramsay镇静评分低于术后12 h,差异有统计学意义(P<0.05)。观察组产妇术后12、24、36 h的Ramsay镇静评分高于对照组,差异均有统计学意义(P<0.05)。观察组产妇的不良反应总发生率低于对照组,差异有统计学意义(P<0.05)。观察组产妇产后4、6周的EPDS评分高于产后2周,差异有统计学意义(P<0.05);对照组产妇产后4、6周的EPDS评分与产后2周比较,差异无统计学意义(P>0.05);观察组产妇产后2、4周的EPDS评分低于对照组,差异有统计学意义(P<0.05);产后6周,两组产妇的EPDS评分比较,差异无统计学意义(P>0.05)。结论地佐辛联合舒芬太尼具有较强的镇痛、镇静效果,术后不需要增加剂量进行镇痛,且不会镇静过度,同时,地佐辛与舒芬太尼的联合使用可降低产妇短期内的产后抑郁发生率。

Objective To investigate the influence on Dezocine combined with Sufentanil on postpartum analgesia effect and postpartum depression after cesarean section.Methods A total of 120 parturients who underwent cesarean section in the Maternal and Child Health Care Hospital of Longgang District in Shenzhen City from July 2019 to June 2020 were selected.According to the double-blind randomized trial design,they were divided into observation group and control group,with 60 parturients in each group.After the operation,both groups of patients used analgesic pumps.The observation group used Dezocine combined with Sufentanil for analgesia,and the control group only used Sufentanil for analgesia.The visual analogue scale(VAS)and Ramsay sedation score were used to evaluate postoperative analgesia and sedation in the two groups.The incidence of adverse reactions in the two groups was statistically analyzed.Edinburgh postnatal depression scale(EPDS)was used to evaluate the scores of maternal depression in the two groups.Results The VAS pain score at 24 h after surgery in the observation group was higher than that at 12 h after surgery,and the difference was statistically significant(P<0.05).There was no significant difference between the VAS pain scores at 36 h after surgery and 12 h after surgery in the observation group(P>0.05).The VAS pain score at 36 h after surgery was lower than that at 12 h after surgery in the control group,and the difference was statistically significant(P<0.05).There was no significant difference between the VAS pain scores at 24 h after surgery and 12 h after surgery in the control group(P>0.05).The VAS pain scores of the observation group at 12,24 and 36 h after surgery were lower than those of the control group,with statistically significant differences(P<0.05).At 24 and 36 h after surgery,Ramsay sedation scores of the two groups were lower than those of 12 h after surgery,the differences were statistically significant(P<0.05).Ramsay sedation scores of observation group at 12,24 and 36 h after surgery were higher than those of control group,with statistically significant differences(P<0.05).The total incidence of adverse reactions in the observation group was lower than that in the control group,and the difference was statistically significant(P<0.05).The EPDS scores of observation group at 4 and 6 weeks postpartum were higher than those at 2 weeks postpartum,and the differences were statistically significant(P<0.05).There were no significant differences in EPDS scores between the control group at 4,6 weeks postpartum and 2 weeks postpartum(P>0.05).EPDS scores of the observation group were lower than those of the control group at 2 and 4 weeks postpartum,the differences were statistically significant(P<0.05).At 6 weeks postpartum,there was no significant difference in EPDS scores between the two groups(P>0.05).Conclusion Dezocine combined with Sufentanil has a strong analgesic and sedative effect.There is no need to increase the dose for analgesia after surgery,and it will not be excessively sedated.At the same time,the combination of Dezocine and Sufentanil may reduce the incidence of postpartum depression in the short term.