艾司氯胺酮复合纳布啡用于剖宫产术后镇痛及产后抑郁

Clinical study of esketamine combined with nabupine for postoperative analgesia and postpartum depression in cesarean section patients

目的:观察艾司氯胺酮复合纳布啡用于剖宫产术后镇痛的效果及对产后抑郁(PPD)的影响。方法:选取择期经腰硬联合麻醉行剖宫产产妇80例,年龄20~40岁,BMI 25~32 kg/m^(2),ASAⅡ级。术后镇痛均采用电子泵静脉自控镇痛(PCIA),采用随机数字表法分为两组,每组40例,舒芬太尼组(S组)和艾司氯胺酮组(E组)。镇痛泵配方:S组用药舒芬太尼注射液1.5μg/kg+纳布啡注射液1 mg/kg,E组用药艾司氯胺酮注射液1.5 mg/kg+纳布啡注射液1 mg/kg,均用生理盐水配至150 mL;镇痛泵参数设置:首次量为3 mL,背景量为2 mL/h,自控量为2 mL/次,锁定时间为15 min。记录术后48 h内药物用量、有效按压次数、总按压次数、镇痛补救例数,术后6、12、24、48 h的VAS评分,术前1 d和术后3、14、30 d的爱丁堡产后抑郁量表(EPDS)评分和PPD的发生率,术后48 h恶心、呕吐、皮肤瘙痒、多梦、视力模糊等不良反应发生率。结果:两组产妇术后48 h内药物用量、有效按压次数、总按压次数、镇痛补救例数、皮肤瘙痒、多梦、视力模糊等不良反应发生率及术后6、12、24、48 h的VAS评分、术前1 d、术后30 d的EPDS评分和PPD发生率差异均无统计学意义(P>0.05)。与S组比较,E组术后3、14 d的EPDS评分、PPD发生率及术后48 h内恶心、呕吐发生率均明显降低(P<0.05)。结论:艾司氯胺酮复合纳布啡可以有效缓解剖宫产术后疼痛及预防产后抑郁,同时减少阿片相关不良反应的发生。

Objective:To observe the analgesic effect of esketamine combined with nalbuphine for postoperative analgesia after caesarean section and the effect of postpartum depression(PPD).Methods:Eighty pregnant women aged 20~40 years old with BMI 25~32 kg/m^(2),ASAⅡ,who were selected for caesarean section under combined spinal epidural anesthesia,were selected.Postoperative analgesia was performed using eletronic pump controlled intravenous analgesia(PCIA).The patients were randomLy divided into two groups with 40 cases in each group.Sufentanil group(group S)was given sufentanil injection 1.5μg/kg+nalbuphine injection 1 mg/kg as the analgesia pump formula and esketamine group(group E)was given esketamine injection 1.5 mg/kg+nalbuphine injection 1 mg/kg,and added normal saline to prepare 150 mL.The parameters of analgesia pump were set as follows:the first dose was 3 mL,the background dose was 2 mL/h,the self-control anount was 2 mL/time,and the locking time was 15 minutes.The drug dosage,effective pressing times.Total pressing times,number of cases of pain relief with in 48 h after surgery.VAS scores at 6 h,12 h,24 h,48 h after surgery.Edinburgh Postnatal Depression Scale(EPDS)scores at 1 d before surgery and 3 d,14 d and 30 d after surgey,and the incidence of PPD was recorded.The incidence of adverse reactions such as naused and vomiting.Skin itchig,dreainess and blurred vision at 48 h after surgery were recorded.Results:There was no significant difference between the two groups in the drug dosage with in 48 h after operation,the number of effective press,the number of total press,the number of cases of pain relief,the incidence of skin itching,dreaminess,blurred vision and other adverse reactions,the VAS score at 6 h,12 h,24 h,48 h after operation,the EPDS score at 1 d before surgery and 30 d after operation,and the incidence of PPD(P>0.05).Compared with group S,the EPDS score,PPD incidence,and nausea and vomiting incidence within 48 h after surgery in group E were significantly reduced at 3 d and 14 d after surgery(P<0.05).Conclusion:Esketamine combined with nalbuphine can effectively relieve pain after caesarean section,prevent postoperative depression,and reduce the occurrence of adverse reactions.