艾司氯胺酮复合布托啡诺对剖宫产术后镇痛效果及产后状态的影响

Effect of esketamine combined with butorphanol for postoperative analgesia of women after cesarean women and its influ-ence on the postpartum status of the women

目的:探究艾司氯胺酮复合布托啡诺对剖宫产产妇术后镇痛效果及产后状态的影响.方法:选择本院2020年5月—2021年6月收治的腰硬联合麻醉下剖宫产术产妇80例,按照随机数字表分为联合组、对照组各40例,对照组术后给予布托啡诺自控静脉镇痛,联合组术后给予艾司氯胺酮复合布托啡诺自控静脉镇痛.比较两组术后2h、6 h、12h、24h、48h静息和宫缩状态下视觉模拟评分法(VAS)评分、Ramsay镇静评分;术前、术后12h、24h、48h血清5-羟色胺(5-HT)、泌乳素(PRL)水平;术后3d、6周爱丁堡产后抑郁量表(EPDS)评分;观察记录产妇产后开奶时间、泌乳开始时间、48h内哺乳次数;统计不良反应情况.结果:联合组术后2h、6h、12h、24h、48h静息和宫缩状态下VAS评分均低于对照组,术后2h、6h、12h、24h时Ramsay评分均优于对照组(均P<0.05);与术前比较,两组术后12h、24h、48h血清5-HT水平均降低,血清PRL水平均提高,且联合组改善程度优于对照组(P<0.05);与对照组比较,术后3d、6周EPDS评分联合组低,泌乳开始时间缩短,48h内哺乳次数增多(均P<0.05);两组不良反应发生率(20.0%、15.0%)无差异(P>0.05).结论:艾司氯胺酮复合布托啡诺可提高剖宫产术后镇痛效应,缓解产妇抑郁症状,促进泌乳功能且安全性好.

Objective:To evaluate the effect of esketamine combined with butorphanol for postoperative analgesia ofwomen after cesarean women,and to study its influence on the postpartum status of the women.Methods:A total of 80 women who wanted cesarean section under combined spinal-epidural anesthesia were selected and were divided into two groups(40 cases in each group)according to the random number table from May 2020 to June 2021.The women in the control group were given butorphanol for patient-controlled intravenous analgesia after cesarean section,and the women in the study group were given esketamine combined with butorphanol for patient-controlled intravenous analge-sia after cesarean section.The visual analogue scale(VAS)score and the Ramsay sedation score of the women at post-operative 2h,6h,12h,24h,and 48h in rest or uterine contraction were compared between the two groups.The levels of serum 5-hydroxytryptamine(5-HT)and prolactin(PRL)of the women at levels before operation,and at postopera-tive 12h,24h,and 48h were compared between the two groups.The score of Edinburgh Postpartum Depression Scale(EPDS)of the women in the postoperative 3rd day and the postoperative 6th weeks were compared between the two groups.The time of postpartum milk feeding,the start of lactation time,and the number of breastfeeding internal postoperative 48h of the women in the two groups were observed and recorded.The rate of adverse reactions of the women in the two groups was counted.Results:The VAS score of the women in the study group at postoperative 2h,6h,12h,24h,or 48h in rest or uterine contraction was significantly lower than that of the women in the control group,and Ramsay scores of the women in the study group at postoperative 2h,6h,12h,or 24h was significantly bet-ter than that of the women in the control(P<0.05).The serum 5-HT level of the women in the two groups at postop-erative 12h,24h,or 48h had decreased significantly and the serum PRL level of the women in the two groups had sig-nificantly increased,and the improvements of which of the women in the study group were significantly better than those of the women in the control group(P<0.05).Compared with those of the women in the control group,the EP-DS score of the women in the study group in the postoperative 3rd day or 6th week was significantly lower,the time of delivery to breasteeding start of the women in the study group was significantly shorter,and the number of breast-feeding within postoperative 48 h of the women in the study group was significantly more(all P<0.05).There was no significant difference in the incidence of adverse reactions(20.0%vs.15.0%)between the two groups(P>0.05).Con-clusion:The combination of esketamine and butorphanol can improve the analgesic effect after cesarean section of the women,which can alleviate their symptoms of depression,promote their improvement of lactation function with better safe.