艾司氯胺酮联合舒芬太尼用于剖宫产术后镇痛对疼痛程度及产后抑郁的影响

Effect of esketamine combined with sufentanil on the degree of pain and postpartum depression after cesarean section

目的 观察艾司氯胺酮联合舒芬太尼用于剖宫产术后镇痛对疼痛程度及产后抑郁的影响。方法 收集腰硬联合麻醉下进行择期剖宫产术的112例足月孕妇作为研究对象,随机分为试验组及对照组,每组56例。2组患者术后均给予静脉自控镇痛泵(PCIA)镇痛,试验组术后镇痛药物方案用盐酸艾司氯胺酮注射液2 mg·kg^(-1)+枸橼酸舒芬太尼注射液2μg·kg^(-1)+托烷司琼10 mg+生理盐水至150 mL,对照组用枸橼酸舒芬太尼注射液3μg·kg^(-1)+托烷司琼10 mg+生理盐水至150 mL。比较2组患者术后2,4,6,12,24,36,48 h的静息视觉模拟评分(VAS)、运动VAS、Ramsay镇静评分。记录并比较2组患者术后3,5,7 d的产后爱丁堡产后抑郁量表(EPDS)抑郁评分,比较2组患者术后额外使用镇痛药的使用率及术后药物不良反应发生率。结果 试验组在术后4,6,12,24,36,48 h的运动VAS分别为(2.21±0.45),(2.53±0.49),(2.87±0.51),(2.85±0.29),(2.68±0.27)和(2.53±0.26)分;对照组分别为(2.49±0.47),(3.03±0.51),(3.31±0.53),(3.19±0.33),(3.06±0.32)和(3.01±0.30)分,差异均有统计学意义(均P<0.05)。试验组静脉镇痛药额外使用率(3.57%)低于对照组(16.07%,P<0.05)。试验组在术后12,24 h的镇静评分分别为(2.36±0.25)和(2.02±0.21)分,高于对照组的(1.82±0.19),(1.69±0.17)分(P<0.05),2组术后2,4,6,36,48 h Ramsay镇静评分差异均无统计学意义(均P>0.05)。术后3,5,7 d试验组产后抑郁评分分别为(8.01±1.51),(8.94±1.75)和(9.06±1.64)分,低于对照组的(9.64±1.59),(10.03±1.69)和(9.73±1.59)分,差异均有统计学意义(均P<0.05)。2组药物不良反应发生率比较,差异无统计学意义(P>0.05)。结论 艾司氯胺酮联合舒芬太尼用于剖宫产术后镇痛,可为产妇提供更好的镇静、镇痛效果,可明显减轻产妇术后运动疼痛程度及产后抑郁程度。

Objective To observe the effect of esketamine combined with sufentanil on pain degree and postpartum depression after cesarean section.Methods A total of 112 full-term pregnant women who underwent cesarean section under combined spinal-epidural anesthesia were selected as the research subjects,and randomly divided into treatment group and control group,with 56 cases in each group.Patients in both groups were given patient controlled intravenous analgesia(PCIA) after operation.Postoperative analgesic plan of treatment group was as follows:2 mg·kg^(-1)esketamine hydrochloride injection +2μg·kg^(-1)sufentanil citrate injection+tropisetron 10 mg+normal saline,150 m L in total.The plan of control group was 3μg·kg^(-1)sufentanil citrate injection+tropisetron 10 mg+normal saline,150 m L in total.The visual analogue scale (VAS) in resting state,VAS scores in motion state and Ramsay sedation scores at 2,4,6,12,24,36and 48 h after operation were compared between the two groups.Postpartum depression scores (Edinburgh Postnatal Depression Scale,EPDS) on day 3,day 5 and day 7 after operation were compared between the two groups.The usage rate of additional analgesics and the incidence of postoperative adverse drug reactions were compared between the two groups.Results The VAS in motion state in treatment group at 4,6,12,24,36 and 48 h after operation were(2.21±0.45),(2.53±0.49),(2.87±0.51),(2.85±0.29),(2.68±0.27) and (2.53±0.26) scores;which in control group were (2.49±0.47),(3.03±0.51),(3.31±0.53),(3.19±0.33),(3.06±0.32) and(3.01±0.30) scores,the difference were all statistically significant (all P<0.05).The usage rate of additional intravenous analgesics in treatment group (3.57%) was lower than that in the control group (16.07%,P<0.05).The sedation scores of the treatment group at 12 and 24 h after operation were (2.36±0.25) and (2.02±0.21)scores,higher than those in control group,which were (1.82±0.19) and (1.69±0.17) scores (P<0.05).There was no significant difference in Ramsay sedation score between the two groups at 2,4,6,36 and 48 h after operation(P>0.05).The postpartum depression scores of the treatment group on day 3,day 5 and day 7 after operation were(8.01±1.51),(8.94±1.75) and (9.06±1.64) scores,lower than those in control group,which were(9.64±1.59),(10.03±1.69) and (9.73±1.59) scores (all P<0.05).There was no significant difference in the incidence of adverse drug reactions between the two groups (P>0.05).Conclusion Analgesia with esketamine and sufentanil after cesarean section can achieve better sedative and analgesic effects,and significantly relieve postoperative pain and postpartum depression.