艾司氯胺酮对肥胖产妇剖宫产术后镇痛及抑郁发生的影响

Effects of esketamine for postoperative analgesia of obese parturient on their pain control and depression after cesarean section

目的:探讨艾司氯胺酮对肥胖产妇(体质指数≥30kg/m^(2))剖宫产术后镇痛及抑郁发生的的影响。方法:选取2021年6月-2022年5月在本院接受剖宫产术的肥胖产妇82例,随机分成两组各41例,术后镇痛药物观察组选用45mg艾司氯胺酮+50μg舒芬太尼+10mg阿扎司琼,对照组选用100μg舒芬太尼+10mg阿扎司琼。术后随访8周,观察两组术中相关指标、镇痛评分(NRS)、产后抑郁评分(EPDS)、镇痛相关不良反应、睡眠质量、产后焦虑和恢复质量等情况。结果:82例均完成术后随访。两组手术时间、麻醉持续时间和术中出血量等无差异(P>0.05)。观察组术后2h、6h、12h、24h、48h时的静息NRS评分均低于对照组,在6h、12h、24h、48h时的运动NRS评分均低于对照组,在术后1周、3周、6周、8周EPDS评分均低于对照组(均P<0.05)。与对照组相比,观察组产妇术后1周的睡眠质量更好,GAD-7评分更低(5.73±2.16分比7.49±2.58分),QoR-15评分更高(122.47±29.51分比108.45±25.66分)(均P<0.05)。结论:艾司氯胺酮可减轻肥胖产妇术后疼痛、缓解产后抑郁状态、促进恢复质量,且安全性好。

Objective:To investigate the effects of esketamine for postoperative analgesia of obese parturient(BMI≥30 kg/m^(2))on their pain control and depression after cesarean section.Methods:A total of 82 obese parturients who had undergone cesarean section were selected and randomly divided into two groups(41 cases in each group)from January 2020 to December 2021.The parturients in the research group were given 45mg estazolam combined with 50μg sufentanil and 10mg azasetron for postoperative analgesia,and the parturient in the control group were given 100μg sufentanil combined with 10mg azasetron for postoperative analgesia.All the parturient were followed up for 8 weeks after operation.The intraoperative related indicators,the NRS analgesic score,the postpartum depression score(EPDS),the analgesic-related adverse reactions,the sleep quality,the postpartum anxiety,and the recovery quality of the parturient in the two groups were observed.Results:All 82 parturient had completed the follow-up.There were no significant differences in the operation time,the anesthesia duration,and the intraoperative blood loss of the parturient between the two groups(P>0.05).The resting NRS scores of the parturient in the research group at 2h,6h,12h,24h,and 48h after operation were significantly lower than those of the parturient in the control group,and the locomotor NRS scores of the parturient in the research group at 6h,12h,24h and 48h after operation were also significantly lower than those of the parturient in the control group.The EPDS scores of the parturient in the research group in 1,3,6 and 8 weeks after operation were significantly lower than those of the parturient in the control group(all P<0.05).Compared with those of the parturient in the control group,the parturient in the research group had better sleep quality,lower GAD-7 score(5.73±2.16 points vs.7.49±2.58 points),and higher QOR-15 score(122.47±29.51 points vs.108.45±25.66 points)(all P>0.05).Conclusion:Esketamine can reduce the postoperative pain degree of the obese parturient,relieve their postpartum depression,and promote their recovery quality,with good safety.