小剂量艾司氯胺酮与右美托咪定对剖宫产术后产妇忧郁和疼痛的疗效比较

Curative effects comparison between low-dose esketamine and dexmedetomidine on maternity blues and pain after cesarean section

目的比较小剂量艾司氯胺酮和右美托咪定在剖宫产术后的抗忧郁及镇痛效果。方法将210例拟行剖宫产术的产妇分为对照组、右美托咪定组和艾司氯胺酮组,每组70例。对照组断脐后接静脉镇痛泵(舒芬太尼1μg/kg+托烷司琼10 mg+生理盐水稀释至100 mL),右美托咪定组向静脉镇痛泵中加入0.5μg/kg右美托咪定,艾司氯胺酮组向静脉镇痛泵中加入0.5 mg/kg艾司氯胺酮。记录各组产妇术后24、48 h的视觉模拟评分(VAS)及术后1、3、5、7、9 d的母亲忧郁量表(MBS)评分和产后忧郁发生率,观察术后24 h内的镇痛药使用量及补救镇痛率,并记录各时间点不良反应的发生情况。结果与对照组比较,术后24、48 h右美托咪定组和艾司氯胺酮组的VAS评分、镇痛药使用量和补救镇痛率均明显降低(P<0.05);而艾司氯胺酮组的VAS评分、镇痛药使用量和补救镇痛率均明显低于右美托咪定组(P<0.05)。术后3、5、7、9 d右美托咪定组和艾司氯胺酮组的MBS评分及产后忧郁发生率均明显低于对照组(P<0.05);而艾司氯胺酮组术后1、3、5、7、9 d的MBS评分及产后忧郁发生率均明显低于右美托咪定组(P<0.05)。3组产妇的术后头痛、幻觉、瘙痒、呼吸抑制、循环抑制、嗜睡发生率比较差异均无统计学意义(P>0.05),但艾司氯胺酮组产妇的术后呕吐发生率明显低于对照组、右美托咪定组(P<0.05)。结论对接受剖宫产的产妇术后持续输注小剂量艾司氯胺酮能提供优于右美托咪定的抗忧郁及镇痛作用。

Objective To compare the antidepressive and analgesic effects between low dose esketamine and dexmedetomidine after cesarean section.Methods A total of 210 puerperas planning to perform cesarean section were divided into the control group,dexmedetomidine group and esketamine group,70 cases in each group.After severing the umbilical cord,the control group received an intravenous analgesic pump(1μg/kg of sufentanil+10 mg of tropisetron+normal saline diluting to 100 mL),the dexmedetomidine group was given 0.5μg/kg of dexmedetomidine to the intravenous pumps,and the esketamine group was added by 0.5 mg/kg of esketamine to the intravenous pumps.The visual analogue scale(VAS)score at postoperative 24,48 h,maternal blues scale(MBS)score on postoperative 1,3,5,7,9 d and the occurrence rate of postpartum maternity blues were recorded.The dosage of analgesics within postoperative 24 h and rate of rescue analgesia were observed.Meanwhile,the occurrence of adverse reactions at each time point was recorded.Results Compared with the control group,the VAS scores,dosage of analgesics and rate of rescue analgesia in the dexmedetomidine group and esketamine group were decreased(P<0.05);whereas the VAS scores,dosage of analgesics and rate of rescue analgesia in the esketamine group were significantly lower than those in the dexmedetomidine group(P<0.05).The MBS score and incidence rate of postpartum maternity blues on postoperative3,5,7,9 d in the dexmedetomidine group and esketamine group were lower than those in the control group(P<0.05);whereas the MBS score and the incidence rate of postpartum maternity blues on postoperative 1,3,5,7,9 d in the esketamine group were significantly lower than those in the dexmedetomidine group(P<0.05).There was no statistically significant difference in the incidence of postoperative headache,hallucinations,itching,respiratory depression,circulatory depression and drowsiness among three groups(P>0.05),while the incidence rate of vomiting in the esketamine group was significantly lower than that in the control group and dexmedetomidine group(P<0.05).Conclusion Continuous infusion of low dose esketamine can provide better antidepressant and analgesic effects than dexmedetomidine in puerperas receiving cesarean section.