艾司氯胺酮对剖宫产术后镇痛及RAAS系统、产后抑郁的影响

Effects of esketamine on postoperative analgesia and RAAS system and postpartum depression after cesarean delivery

目的分析艾司氯胺酮对剖宫产术后镇痛及肾素-血管紧张素-醛固酮系统(RAAS)、产后抑郁情况发生的影响。方法研究对象为2020年5月—2021年6月在我院行剖宫产的96例孕产妇,根据麻醉药物的不同分为研究组50例和对照组46例,2组孕产妇均给予腰硬联合麻醉行剖宫产术,研究组于手术切皮前5 min静脉注射艾司氯胺酮0.2 mg/kg,对照组静脉注射等量生理盐水。比较2组孕产妇术后疼痛评分(VAS评分)、肾素活性(PRA)、血管紧张素-Ⅱ(AT-Ⅱ)、醛固酮(ALD)、爱丁堡产后抑郁量表(EPDS)、不良反应的发生情况。结果与对照组比较,术后各时间点研究组孕产妇VAS评分均明显较低,差异具有统计学意义(P<0.01)。2组T1、T2、T3各时间点RAAS各指标均明显低于T0时间点(P<0.05);研究组在T1、T2时间点RAAS各指标均明显低于对照组,差异具有统计学意义(P<0.05)。研究组术后3 d、术后6周EPDS评分均明显低于对照组(P<0.01)。2组不良反应总发生率比较无差异(P>0.05)。结论艾司氯胺酮用于剖宫产术后镇痛效果显著,对产妇RAAS影响较小,并可缓解产妇抑郁症状,且不良反应发生率较低。

Objective To analyze the effect of esketamine on analgesia and renin angiotensin aldosterone system(RAAS)and the occurrence of postpartum depression after cesarean delivery.Methods The subjects were 96 pregnant women who underwent cesarean section in our hospital from May 2020 to June 2021,they were divided into 50 cases in the study group and 46 cases in the control group.Both groups of pregnant women were given combined spinal epidural anesthesia for cesarean section.The patients in study group were injected with esmketamine 0.2 mg/kg intravenously 5 minutes before skin incision,and those in control group were injected with the same amount of saline intravenously.The postoperative pain scores(VAS score),plasma renin activity(PRA),angiotensin-Ⅱ(AT-Ⅱ),aldosterone(ALD),Edinburgh Postpartum Depression Scale(EPDS),and the occurrence of adverse effects were compared between the two groups.Results Compared with the control group,maternal VAS scores were significantly lower in the study group at all postoperative time points,and the differences were statistically significant(P<0.01).The indexes of RAAS were significantly lower in both groups at T1,T2 and T3 time points than at T0 time point(P<0.05);the indexes of RAAS were significantly lower in the study group at T1 and T2 time points than in the control group,and the differences were statistically significant(P<0.05).The postoperative EPDS scores in the study group were significantly lower than those in the control group at 3 d and 6 weeks(P<0.01).There was no difference in the overall incidence of adverse reactions between the two groups(P>0.05).Conclusions Esketamine is effective for postoperative analgesia after cesarean section,with less effect on maternal RAAS,and can relieve maternal depressive symptoms,and has a low incidence of adverse reactions.