艾司氯胺酮复合布托啡诺PCIA对剖宫产术后镇痛、炎性细胞因子和产后抑郁的影响

Effect of esketamine combined with butorphanol PCIA on analgesia,inflammatory cytokines and postpartum depression in puerpera undergoing cesarean section

目的:探讨艾司氯胺酮复合布托啡诺自控静脉镇痛(PCIA)对剖宫产术后镇痛、炎性细胞因子和产后抑郁的影响。方法:选取120例剖宫产孕产妇为研究对象,根据术后镇痛治疗方式不同分为对照组与观察组,每组各60例;两组孕产妇术毕均行PCIA。对照组孕产妇采用布托啡诺0.15 mg/kg+帕洛诺司琼0.15 mg镇痛治疗;观察组孕产妇采用布托啡诺0.1 mg/kg+艾司氯胺酮1 mg/kg+帕洛诺司琼0.15 mg镇痛治疗,均镇痛治疗至术后48 h。比较两组孕产妇术后6~48 h疼痛情况[视觉模拟评分(VAS评分)],术后恢复情况,术前及术后24 h血清肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)、IL-1β水平,术后3 d、7 d、6周抑郁发生率[爱丁堡产后抑郁量表(EPDS)评分]及不良反应发生情况。结果:相比对照组,观察组孕产妇6~24 h静息时和活动时的VAS评分均降低(P<0.05);术后肛门排气时间、膀胱恢复排尿时间及初乳时间均提前(P<0.05)。术后24 h,两组孕产妇血清TNF-α、IL-6、IL-1β水平均高于术前(P<0.05),但观察组低于对照组(P<0.05)。观察组孕产妇术后3 d、7 d产后抑郁发生率低于对照组(P<0.05)。两组孕产妇不良反应发生率比较,差异无统计学意义(P>0.05)。结论:剖宫产术后PCIA复合使用艾司氯胺酮与布托啡诺能够减轻产妇术后疼痛,可抑制炎症反应,利于术后恢复,且对产后抑郁有较好的预防作用。

Objective:To investigate the effect of esketamine combined with butorphanol self-controlled intravenous analgesia(PCIA)on analgesia,inflammatory cytokines and postpartum depression in puerpera undergoing cesarean section.Methods:A total of 120 pregnant women with cesarean section were divided into control group and observation group according to different postoperative analgesia methods,60 cases in each group.PCIA was performed in both groups after operation.The drug formula in the control group was 0.15 mg/kg butorphanol+0.15 mg palonosetron,and the drug formula in the observation group was 0.1 mg/kg butorphanol+1mg/kg esketamine+0.15 mg palonosetron,with analgesia until 48 h after operation.The pain situation[visual analogue score(VAS score)]at 6~48 h after operation,postoperative recovery,serum tumor necrosis factor-α(TNF-α),interleukin-6(IL-6)and IL-1βlevels before and 24 h after operation,rate of depression[Edinburgh Postnatal Depression Scale(EPDS)score]at 3 d,7 d and 6 w after operation and adverse reactions of pregnant women in the two groups were compared.Results:The VAS scores at rest and at activity in the observation group at 6~24 h were lower than those in the control group(P<0.05).The anal exhaust time,bladder recovery urination time and colostrum time in the observation group were advanced comparing with the control group(P<0.05).The serum TNF-α,IL-6 and IL-1βlevels at 24 h after operation in the two groups were higher than those before operation(P<0.05),the observation group was lower than the control group(P<0.05).The incidence of postpartum depression in the observation group was lower than that in the control group at 3 and 7 d after operation(P<0.05).There was no statistically significant difference in the incidence of adverse reactions between the two groups(P>0.05).Conclusion:PCIA combined with esketamine and butorphanol after cesarean section can reduce maternal postoperative pain,inhibit inflammatory response,facilitate postoperative recovery,and prevent postpartum depression.