艾司氯胺酮联合纳布啡PCIA对剖宫产术后镇痛、恢复质量和产后抑郁的影响

Effects of esketamine combined with nalbuphine for patient-controlled intravenous analgesia of women on their analgesia,recovery quality,and postpartum depression after cesarean section

目的:探讨艾司氯胺酮联合纳布啡自控静脉镇痛(PCIA)对剖宫产术后镇痛、恢复质量和产后抑郁的影响。方法:2021年1月-2022年12月在本院行剖宫产术孕产妇240例随机分为对照组与观察组各120例。术毕,两组均予以PCIA,对照组药液配方为纳布啡2 mg/kg+生理盐水稀释到200ml,观察组药液配方为纳布啡2 mg/kg+艾司氯胺酮1mg/kg+生理盐水稀释到200ml,镇痛持续至术后48h。记录两组产妇术后6h、12h、24h、48h疼痛视觉模拟(VAS)评分,术后恢复情况;于术前1h、术后24h及48h检测产妇血清泌乳素(PRL)水平;于术后5d进行40项恢复质量量表(QoR-40)评分评价产妇整体恢复情况;统计两组术后3d、7d和6周产后抑郁发生率;术后48h内不良反应。结果:与对照组比较,观察组术后6~48h VAS评分(静息时和活动时)均降低,术后下床活动时间(13.45±2.39h比14.78±3.14h)、肛门排气时间(21.45±5.41h比23.78±4.62)均缩短,泌乳始动时间(24.22±5.44h比29.35±5.78h)提前,48h哺乳次数(8.25±1.76次比6.49±1.58次)增多,术后24h、48h PRL水平均高于对照组,术后5d QoR-40评分(175.12±5.39分)高于对照组(168.66±5.67分),术后3d、7d产后抑郁发生率(5.8%、9.2%)低于对照组(17.5%、22.5%)(均P<0.05)。术后48h内不良反应(17.5%)与对照组(16.7%)无差异(P>0.05)。结论:艾司氯胺酮联合纳布啡用于剖宫产术后PCIA,不仅能够产生较好镇痛效果,还能够减少产后抑郁的发生,提高产妇术后恢复质量。

Objective:To investigate the effects of esketamine combined with nalbuphine for patient-controlled intrave-nous analgesia(PCIA)of women on their analgesia,recovery quality,and postpartum depression after cesarean sec-tion.Methods:A total of 240 women after cesarean section were randomly divided into two groups(120 cases in each group)from January 2021 to Dcember 2022.At the end of the cesarcan section,the women in both groups were given PCIA for analgesia to postoperative 48h.The women in the control group were given PCIA with nalbuphine2 mg/kg in normal saline 200 ml,and the women in the experimental group were given PCIA with nalbuphine 2 mg/kg combined with esketamine 1 mg/kg in normal saline 200 ml.The visual analogue scale(VAS)scores at postoperative 6h,12h,.24h,and 48h and the recovery situation of the women in the two groups were recorded.The serum prolactin(PRL)level of the women in the two groups at 1 h before operation,or at 24 h or 48 h after operation was measured.The score by 40 item quality of recovery scale(QoR-40)of the women in the two groups in 5 days after operation was per-formed to evaluate their overall recovery situation.The incidences of the postpartum depression of the women in the two groups in3 days,7 days,and 6 weeks after operation were counted.The adverse reactions of the women in the two groups within 48h after operation were observed.Results:The VAS scores(both at resting and active)of the women in the experimental group at 6-48h after operation were significantly lower than those of the women in the control group.The time of getting out of bed(13.45±2.39h),the time of anal exhaust(21.45±5.41h),and the time of lactation initiation(24.22±5.44h)of the women in the experimental group were significantly shorter than those(14.78±3.14h,23.78±4.62,and 29.35±5.78h)of the women in the control group.The lactation times(8.25±1.76.times)of the women in the experimental group in 48h after operation was significantly higher than that(6.49±1.58 times)of the women in the control group.The PRL level of the women in the experimental group at 24h and 48h after operation was significantly higher than that of the women in the control group.The score of QoR-40(175.12±5.39 points)of the women in the experimental group in the 5th day after operation was significantly higher than that(168.66±5.67 points)of the women in the control group.The incidences of the postpartum depression of the women in the experimental group in 3 and 7 days after operation(5.8%and 9.2%)were significantly lower than those(17.5%and 22.5%)of the women in the control group(all P<0.05).There was no significant difference in the adverse reac-tions rate(17.5%vs.16.7%)of the women within 48h after operation between the two groups(P>0.05).Conclusion:Esketamine combined with nalbuphine for PCIA of the women after cesarean section can not only has better analgesic efct.but also reduce the incidence of the postpartum depression and improve the quality of postoperative recovery of the women.