静脉输注艾司氯胺酮对剖宫产术后镇痛及产后抗抑郁效果的影响

Effects of intravenous infusion of esketamine on analgesia and postpartum antidepressant after cesarean section

目的:剖宫产术后疼痛及产后抑郁影响产妇产后生理和心理的康复,艾司氯胺酮作为氯胺酮的右旋体,有镇痛及抗抑郁的作用。本研究探讨静脉输注艾司氯胺酮对剖宫产产妇术后镇痛及产后抑郁的影响。方法:选取腰硬联合麻醉下行剖宫产手术产妇435例,随机分为三组,均在术中胎儿娩出后5 min持续静脉泵注,HE组:0.4 mg/kg艾司氯胺酮;LE组:0.2 mg/kg艾司氯胺酮;C组:生理盐水。术中记录入室(T_(0)),切皮(T_(1)),开始泵注(T_(2)),泵注10 min(T_(3)),泵注20 min(T_(4)),泵注结束(T_(5)),手术结束(T_(6))时的MAP和HR,观察离室前不良反应。术后三组产妇均连接静脉镇痛泵镇痛:舒芬太尼2.5μg/kg+昂丹司琼8 mg+生理盐水共100 mL。观察术后2 h(T_(0)’)、4 h(T_(1)’)、8 h(T_(2)’)、12 h(T_(3)’)、24 h(T_(4)’)VAS评分和舒芬太尼消耗量及不良反应发生情况;用爱丁堡产后抑郁量表(EPDS),评估产妇术前1 d,术后1 d、3 d、1周及6周后的抑郁状态。结果:术中三组平均动脉压(MAP)和心率(HR)差异无统计学意义(P>0.05),与C组相比,HE组和LE组头晕、复视的发生率较高(P<0.05);与C组相比,HE组和LE组VAS评分、舒芬太尼消耗量、术后1 d及3 d的EPDS评分降低(P<0.05)。结论:艾司氯胺酮用于剖宫产术后镇痛效果显著,可以减少阿片类药物使用,并且能改善产妇短期内的抑郁状态。

Objective:Postpartum depression and postoperative pain affect postpartum physical and psychological rehabili⁃tation.Esketamine,as a dexer of ketamine,has analgesic and antidepressant effects.This study was to investigate the effect of in⁃travenous infusion of esmololone on postoperative analgesia and postpartum depression in parturients undergoing cesarean section.Methods:435 parturients undergoing cesarean section under combined spinal and epidural anesthesia were randomly divided into three groups.All of them were given continuous intravenous infusion 5 minutes after delivery of the fetus.HE group 0.4 mg/kg es⁃ketamine,LE group:0.2 mg/kg esketamine,group C:saline.Intraoperative records of MAP and HR at entry(T_(0)),skin resec⁃tion(T_(1)),beginning of pumping(T_(2)),10 min of pumping(T_(3)),20 min of pumping(T_(4)),end of pumping(T_(5)),end of opera⁃tion(T_(6))and the adverse reactions before leaving the room were observed.Postoperative analgesia with intravenous analgesia pump sufentanil 2.5μg/kg+ondansetron 8 mg+saline 100 mL.VAS score and sufentanil consumption and adverse reactions were observed at 2 h(T_(0)’)、4 h(T_(1)’)、8 h(T_(2)’)、12 h(T_(3)’)、24 h(T_(4)’)after operation.The Edinburgh Postpartum Depression Scale(EPDS)was used to evaluate the depression status of pregnant women 1 d before operation,1 d,3 d,1 week and 6 weeks after operation.Results:There was no significant difference in mean arterial pressure(MAP)and heart rate(HR)among the three groups(P>0.05).Compared with group C,the incidence of dizziness and diplopia was higher in group HE and LE(P<0.05).Compared with group C,VAS score,sufentanil consumption,EPDS score at 1 d and 3 d after operation in group HE and LE de⁃creased(P<0.05).Conclusion:The analgesic effect of esketamine after cesarean section is remarkable,which can reduce the use of opioids and improve the short⁃term depression of pregnant women.