艾司氯胺酮对高龄产妇剖宫产术后抑郁和恢复质量的影响

Effects of esketamine on depression and quality of recovery after cesarean section in advanced maternal age women

目的探讨术中单次应用艾司氯胺酮对高龄产妇剖宫产术后早期抑郁及恢复质量的影响。方法选取拟择期行剖宫产术的高龄产妇160例,随机分为对照组和试验组,每组80例。2组均采用腰硬联合麻醉,术中取出胎儿后,试验组给予艾司氯胺酮0.5 mg·kg^(-1)静脉注射,对照组不作特殊处理。采用爱丁堡产后抑郁量表(EPDS)评估抑郁发生情况,采用40项恢复质量量表(QoR-40)评价产妇整体恢复质量,并记录产妇首次下床活动时间、首次肛门排气时间、首次哺乳时间、术后48 h哺乳次数和住院时间,以及不良反应发生情况。结果2组产妇年龄、体重指数、孕龄、手术时间、术中出血量、术后自控镇痛液用量等比较均无显著差异(P>0.05),且术前EPDS评分及抑郁发生率、QoR-40各项评分及总分比较也无显著差异(P>0.05)。与术前相比,对照组术后1 d和术后5 d的EPDS评分和抑郁发生率均升高(P<0.05),试验组无明显变化(P>0.05)。与对照组相比,试验组术后1 d和术后5 d的EPDS评分和抑郁发生率较低(P<0.05),术后5 d的QoR-40中身体舒适度、情绪状态、心理支持、疼痛评分及总分较高(P<0.05)。且与对照组相比,试验组首次下床活动时间、首次肛门排气时间和住院时间缩短,首次哺乳时间提早,术后48 h哺乳次数增多(P<0.05)。2组不良反应发生率无显著差异(P>0.05)。结论术中给予艾司氯胺酮0.5 mg·kg^(-1)具有较持久的抗抑郁作用,可有效改善高龄产妇剖宫产术后抑郁情绪,提高术后恢复质量。

AIM To investigate the effects of single dose of esketamine on early depression and recovery quality of advanced maternal age(AMA)women after cesarean section.METHODS Women of AMA who planned to receive elective cesarean section were randomly divided into control group and trial group,with 80 cases in each group.The parturient in both groups received combined spinal and epidural anesthesia.After the fetus was deliveried,the trial group was intravenously given esketamine 0.5 mg·kg^(-1)slowly while the control group was not given any special treatment.The Edinburgh Postpartum Depression Scale(EPDS)score and the incidence of postpartum depression were compared between the two groups.The overall recovery quality of the two groups was evaluated by 40-item quality of recovery questionnaire(QoR-40),and the time of first postoperative activity,first anal exhaust,first lactation,frequency of lactation in postoperative 48 h,and length of hospital stay were recorded.The adverse reactions were also observed.RESULTS There were no significant differences in maternal age,body mass index,gestational age,operation time,intraoperative bleeding,and postoperative patient-controlled analgesic dosage between the two groups(P>0.05).And there was no significant difference in the preoperative EPDS score,incidence of depression,preoperative QoR-40 contents and total score between the two groups(P>0.05).Compared with those before surgery,EPDS score and incidence of depression were increased at postoperative day 1 and 5 in the control group(P<0.05),while no obvious changes in the trial group(P>0.05).Compared with the control group,EPDS score and incidence of depression were lower in the trial group at postoperative day 1 and 5(P<0.05),and higher physical comfort score,emotional state score,psychological support score,pain score and total score of QoR-40 at postoperative day 5(P<0.05).Postoperative activity,first anal exhaust,first lactation and hospital discharge was earlier,and lactation was more frequent in postoperative 48 h in the trial group(P<0.05).No significant difference was found in the incidence of adverse reactions between the two groups(P>0.05).CONCLUSION Esketamine can effectively and lastingly relief postpartum depression in women of AMA,which is beneficial to the rapid recovery of caesarean section.