艾司氯胺酮在剖宫产术后镇痛中的应用效果及对产妇术后康复质量的影响

Effect of Esketamine in Analgesia after Cesarean Section and Its Influence on the Quality of Postoperative Rehabilitation of Parturient

目的:探讨艾司氯胺酮在剖宫产术后镇痛中的应用效果及对产妇术后康复质量的影响。方法:选取2020年1月—2021年1月武穴市第一人民医院收治的行剖宫产术的产妇134例,使用随机数字表法将其分为观察组和对照组,各67例。对照组产妇断脐后接静脉镇痛泵(舒芬太尼+托烷司琼),观察组在对照组基础上向静脉镇痛泵中加入艾司氯胺酮。对比两组视觉模拟评分法(VAS)评分、40项恢复质量(QoR-40)评分、抑郁评分及相关因子水平,以及术后恢复指标和不良反应发生率。结果:观察组术后2、4、12、24 h的VAS评分均低于对照组(P<0.05)。观察组术后24、48 h的身体舒适度、精神状态、疼痛评分均高于对照组(P<0.05),但两组心理支持和自理能力评分比较,差异均无统计学意义(P>0.05)。观察组术后1、4周的爱丁堡产后抑郁量表(EPDS)评分均低于对照组(P<0.05);术毕,两组去甲肾上腺素(NE)及脑源性神经营养因子(BDNF)水平比较,差异均无统计学意义(P>0.05);术后48 h,两组NE水平降低,观察组低于对照组,BDNF水平上升,观察组高于对照组(P<0.05)。观察组初次床边活动时间、初次排气时间、尿管拔除时间及首次泌乳时间均早于对照组(P<0.05)。观察组的不良反应发生率(1.49%)低于对照组(13.43%)(P<0.05)。结论:艾司氯胺酮在剖宫产术后镇痛中的效果良好,可提高产妇术后康复质量,有效缓解产妇术后抑郁情绪,安全性较高。

Objective:To investigate the effect of Esketamine in analgesia after cesarean section and its influence on the quality of postoperative rehabilitation of parturient.Method:A total of 134 parturients who underwent cesarean section in Wuxue NO.1 People's Hospital from January 2020 to January 2021 were selected and divided into observation group and control group according random number table method,with 67 cases in each group.The control group received intravenous analgesic pump(Sufentanil+Tropisetron)after umbilical amputation,and the observation group added Esketamine to the intravenous analgesic pump based on the control group.Visual analogue scale(VAS)score,quality of recovery 40-item(QoR-40)score,depression score and related factors levels,postoperative recovery indexes and incidence of adverse reactions were compared between the two groups.Result:2,4,12 and 24 h after surgery,the VAS scores of the observation group were lower than those of the control group (P<0.05). 24 and 48 h after surgery, the scores of physical comfort, mental state and pain of the observation group were higher than those of the control group (P<0.05), but there were no statistical significances in the scores of psychological support and self-care ability between the two groups (P>0.05). 1 and 4 weeks after surgery, the Edinburgh postpartum depression scale (EPDS) scores of the observation group were lower than those of the control group (P<0.05). Finish the surgery, there were no significant differences in the levels of norepinephrine (NE) and brain derived neurotrophic factor (BDNF) between the two groups (P>0.05). 48 h after surgery, NE levels decreased in both groups, that in the observation group was lower than that in the control group, BDNF levels increased in both groups, that in the observation group was higher than that in the control group (P<0.05). The first bedside activity time, the first exhaust time, the urinary tube extraction time and the first lactation time in the observation group were earlier than those in the control group (P<0.05). The incidence of adverse reactions in observation group (1.49%) was lower than that in control group (13.43%) (P<0.05). Conclusion: Esketamine has a good effect in postoperative analgesia after cesarean section, which can improve the quality of postoperative rehabilitation of parturients, effectively relieve postoperative depression of parturients, and has a high safety.