艾司氯胺酮对胎盘植入行剖宫产患者产后抑郁的影响

Effect of esketamine on postpartum depression in patients undergoing cesarean section with placenta implantation

目的探讨艾司氯胺酮对胎盘植入行剖宫产患者产后抑郁的影响。方法选择2020年4月至2022年3月于河北省人民医院就诊的60例胎盘植入患者,按随机数字表法分为观察组和对照组,各30例。2组均采用腰硬联合麻醉下剖宫产术,术中胎儿娩出后,观察组静脉注射艾司氯胺酮0.2 mg/kg,后续以0.25 mg/(kg·h)持续静脉泵注至手术结束,对照组同时间给予与观察组等容量的0.9%氯化钠注射液。比较2组患者基本资料及术中情况。于术后2、4、6、12和24 h采用疼痛视觉模拟量表(VAS)评估患者疼痛程度。于术前1 d、术后3、7 d和6周采用爱丁堡产后抑郁量表(EPDS)评价产后抑郁情况。记录2组不良反应总发生率。结果2组子宫切除率、术中出血量差异均无统计学意义(均P>0.05)。术后2、4、6、12和24 h时观察组VAS评分明显低于对照组,差异均有统计学意义(均P<0.01)。观察组术后6周时产后抑郁总发生率低于对照组[16.7%(5/30)比40.0%(12/30)],差异有统计学意义(P<0.05)。2组患者不良反应总发生率差异无统计学意义(P>0.05)。结论艾司氯胺酮可减轻胎盘植入患者剖宫产术后疼痛,改善患者产后抑郁。

Objective To investigate the effect of Esketamine on postpartum depression in patients undergoing cesarean section with placenta implantation.Methods From April 2020 to March 2022,60 patients with placental implantation treated in the Hebei General Hospital were selected.According to random number table method,they were divided into observation group and control group,with 30 cases in each group.Both groups underwent cesarean section under combined spinal⁃epidural anesthesia.After the delivery of the fetus during the operation,the observation group received intravenous infusion of 0.2 mg/kg of esketamine,followed by continuous intravenous infusion of 0.25 mg/(kg·h)until the end of the operation.The control group received an equivolume of 0.9%sodium chloride injection to the observation group at the same time.The basic data and intraoperative conditions of patients in the two groups were compared.The degree of pain was assessed by the pain Visual Analogue Scale(VAS)at 2,4,6,12 and 24 h after surgery.The Edinburgh Postpartum Depression Scale(EPDS)was used to assess postpartum depression 1 d before surgery,3,7 d,and 6 weeks after surgery.The total incidence of adverse reactions were recorded in the two groups.Results There was no significant difference in hysterectomy rate and intraoperative bleeding between the two groups(all P>0.05).At 2,4,6,12 and 24 h after surgery,the VAS score in the observation group was significantly lower than that in the control group(all P<0.01).The total incidence of postpartum depression in the observation group at 6 weeks after surgery was lower than that in the control group[16.7%(5/30)vs 40.0%(12/30)](P<0.05).There was no significant difference in the total incidence of adverse reactions in the two groups(P>0.05).Conclusion Esketamine can reduce pain after cesarean section in patients with placenta implantation,and improve postpartum depression.