艾司氯胺酮联合盐酸罗哌卡因对分娩镇痛及产后抑郁的影响

Effects of esketamine combined with ropivacaine on labor analgesia and postpartum depression

目的探讨艾司氯胺酮联合盐酸罗哌卡因应用于分娩镇痛的临床效果及对产后抑郁的影响。方法将单胎足月初产妇100例分为艾司氯胺酮联合盐酸罗哌卡因组(联合组)和盐酸罗哌卡因组(罗哌卡因组)。两组采用硬膜外镇痛泵镇痛。记录两组分娩镇痛前、镇痛后5、15、20 min的疼痛视觉模拟(VAS)评分、Ramsay评分及血流动力学指标;记录两组胎儿脐动脉、脐静脉血气分析指标、产后1周和6周爱丁堡产后抑郁量表(EPDS)评分和脑源性神经营养因子(BDNF)水平。观察两组镇痛后的不良反应发生情况。结果与罗哌卡因组比较,联合组镇痛后5、15、20 min的VAS评分降低(P<0.05),Ramsay评分升高(P<0.05)。两组血流动力学指标、胎儿脐动脉、脐静脉血气分析指标差异无显著性。联合组产后1周和6周EPDS评分低于罗哌卡因组(P<0.05),BDNF水平高于罗哌卡因组(P<0.05);联合组不良反应发生率低于罗哌卡因组。结论艾司氯胺酮联合盐酸罗哌卡因用于分娩镇痛效果好,不良反应发生率低,对新生儿无明显影响,且有利于降低产后抑郁的发生。

Aim To investigate the clinical effect of esketamine combined with ropivacaine hydrochloride on labor analgesia and its effect on postpartum depression.Methods A total of 100 full-term primiparas were divided into two groups:esketamine combined with ropivacaine hydrochloride group(combined group)and ropivacaine group.Epidural analgesia pump was used in both groups,and combined group was used esketamine combined with ropivacaine hydrochloride.Visual analog scale(VAS)score,Ramsay score and hemodynamic index were recorded before and 5,15 and 20 min after analgesia;Umbilical artery and umbilical vein blood gas,edinburgh postpartum depression scale(EPDS)scores and brain-derived neurotrophic factor(BDNF)levels were recorded at 1 and 6 weeks postpartum.The incidence of adverse reactions after analgesia was recorded in the two groups.Results Compared with the ropivacaine group,the VAS scores of the combined group were decreased at 5,15 and 20 min after analgesia(P<0.05),while Ramsay scores were increased(P<0.05).There was no significant difference in blood gas analysis of hemodynamic indexes,fetal umbilical artery and umbilical vein.The EPDS score at 1 and 6 weeks postpartum in the combined group was lower than that in the ropivacaine group(P<0.05),and the BDNF level was higher than that in the ropivacaine group(P<0.05).The incidence of adverse reactions in esketamine combined group was lower than that in ropivacaine hydrochloride group.Conclusion Esketamine combined with ropivacaine hydrochloride has good analgesic effect,low incidence of adverse reactions,no obvious effect on neonates,and is beneficial to reduce the occurrence of postpartum depression in patients.