右美托咪定复合舒芬太尼患者静脉自控镇痛对剖宫产产妇术后短期焦虑和抑郁情绪的影响

Effect of patient-controlled intravenous analgesia with dexmedetomidine combined with sufentanil on short-term anxiety and depression in patients after cesarean section

目的观察右美托咪定联合舒芬太尼患者静脉自控镇痛对剖宫产产妇术后短期焦虑和抑郁情绪的影响。方法选择行剖宫产术孕妇100例,年龄22~43岁,美国麻醉医师协会(American Society of Anesthesiologists,ASA)分级Ⅰ~Ⅱ。采用随机数字表法将所有产妇随机分为生理盐水+舒芬太尼组(S组)和右美托咪定+舒芬太尼组(DS组),每组50例。患者进入手术室时(T0),术后3 h(T1),术后6 h(T2),术后12 h(T3),术后24 h(T4),术后48 h(T5),术后72 h(T6)对患者进行Zung抑郁自评量表评分、状态-特质焦虑问卷评分、Richmond躁动-镇静评分和视觉模拟评分。观察2组术后自控镇痛按压次数以及舒芬太尼和曲马多用量、术后肛门排气时间、泌乳时间、恶心呕吐情况、瘙痒以及心动过缓发生情况并记录。结果2组T0~T6时刻Zung抑郁自评量表评分逐渐降低,DS组比S组降低地更明显(P<0.05),2组T0~T6时刻S-AI和T-AI评分逐渐降低,DS组比S组降低地更明显(P<0.05),T2~T4时,DS组RASS评分低于S组,差异有统计学意义(P<0.05),2组VASR和VASW评分均呈现先升高后降低的趋势,S组变化比DS组更为明显,且均高于DS组(P<0.05),S组曲马多补救镇痛用量和PCA按压次数均较DS组显著增加(P<0.05),DS组术后产妇开始泌乳时间和肛门排气时间较S组缩短,DS组术后产妇恶心呕吐发生率较S组显著减少(P<0.05)。2组产妇心动过缓和皮肤瘙痒发生情况差异无统计学意义(P>0.05)。结论右美托咪定联合舒芬太尼静脉患者自控镇痛可以有效缓解剖宫产术后产妇的焦虑和抑郁情绪,增强术后镇痛效果,并促进产妇术后早期泌乳。

Objective To observe the effect of patient-controlled intravenous analgesia(PCIA)with dexmedetomidine combined with sufentanil on short-term anxiety and depression in patients after cesarean section.Methods A total of 100 patients aged 23-40 years with American Society of Anesthesiologists(ASA)Ⅰ-Ⅱwho underwent elective cesarean section were randomly divided into normal saline+sufentanil group(S group,n=50)and dexmedetomidine+sufentanil group(DS group,n=50).The Zung Self-Rating Depression Scale(SDS),State-Trait Anxiety Inventory(STAI),Richmond agitation-sedation scale and visual analog score were applied immediately after entry into the operating room(T0),and at 3 h(T1),6 h(T2),12 h(T3),24 h(T4),48 h(T5)and 72 h(T6)after operation.The frequency of PCIA compression,the dosage of sufentanil and tramadol consumed,time to postoperative anal exhaust,time of lactation initiation,the incidences of nausea and vomiting,pruritus and bradycardia were observed and recorded in two groups.Results The Zung SDS scores gradually decreased at T0-T6 in the two groups,with the DS group showing a more significant decrease compared to the S group(P<0.05).The S-AI and T-AI scores gradually decreased at T0-T6 in the two groups,with the DS group showing a more significant decrease compared to the S group(P<0.05).At T2-T4,the RASS score in the DS group was lower than that in the S group,with a statistically significant difference(P<0.05).The VASR and VASW scores in both groups showed a trend of first increasing and then decreasing,with the S group showing a more significant change compared to the DS group,and both scores were higher than those in the DS group(P<0.05).The dosage of tramadol consumed for relief analgesia and the frequency of PCA compression in the S group were significantly increased compared to those in the DS group(P<0.05).The time to postpartum lactation initiation and anal exhaust in the DS group were shortened compared with those in the S group,and the incidence of postoperative nausea and vomiting in the DS group was significantly reduced compared with those in the S group(P<0.05).There was no statistically significant difference in the occurrence of bradycardia and pruritus between the two groups of postpartum women(P>0.05).Conclusion PCIA with dexmedetomidine combined with sufentanil can effectively alleviate maternal anxiety and depression after cesarean section,enhance postoperative analgesic effect,and promote early lactation after cesarean section.