艾司氯胺酮对剖宫产妇女产后抑郁及术后疼痛的影响

Effects of esketamine on postpartum depression and postoperative analgesia in women after cesarean section

目的探讨艾司氯胺酮能否改善剖宫产产后抑郁,并减轻产妇术后疼痛,促进产妇的快速康复。方法椎管内麻醉下行剖宫产手术产妇91例,分为艾司氯胺酮组(ES组)和对照组(D组),ES组45例,D组46例。所有手术患者术毕均予以术后镇痛(PCIA)。ES组:艾司氯胺酮0.5mg/kg+布托啡诺0.1mg/kg+帕洛诺司琼0.25mg+生理盐水稀释成100ml;D组:布托啡诺0.15mg/kg+帕洛诺司琼0.25mg+生理盐水稀释成100ml。镇痛泵参数设为两组一致(输注量为2ml/h)。记录两组术后4h、12h、24h及48h的静息、运动、宫缩状态时的VAS疼痛评分。记录术前1天,术后2天和术后1月的爱丁堡产后抑郁量表评分(Edinburgh Postnatal Depression Scale,EPDS)。检测术前和术后2天的脑源性神经营养因子(Brain-derived neurotrophic factor,BDNF)的浓度。结果ES组产妇在静息、运动及宫缩状态时VAS评分多时间点总体比较优于D组(P<0.05)。ES组产后2天和产后1月EPDS评分低于D组(P<0.05)。两组患者术后BDNF浓度比较无统计学差异(P>0.05)。结论艾司氯胺酮能改善剖宫产产妇产后抑郁情绪,降低EPDS评分,并能有效缓解剖宫产产妇术后疼痛。

Objective To investigate whether esketamine can improve depression in women after cesarean section,reduce pain after obstetrics and gynecology,and promote rapid recovery of parturients.Methods There were 91women undergoing cesarean section under neuraxial anesthesia,divided into esketamine group(ES group)and control group(D group),45 cases in ES group and 46 cases in D group.All surgical patients are given PCIA at the end of surgery.ES group:es-ketamine 0.5mg/kg+butorphanol 0.1mg/kg+palonosetron 0.25mg+normal saline diluted into 100ml;Group D:Butorphanol 0.15mg/kg+Palonoseron 0.25mg+normal saline diluted to 100ml.The analgesia pump parameters were set to be consistent between the two groups(infusion volume of 2 ml/h).The VAS pain scores of resting,exercise,and contraction states at rest,4h,12h,24h,and 48h after surgery were recorded in the two groups.EPDS scores were recorded 1 day before,2 days postoperatively,and 1 month postoperatively.Concentrations of BDNF were measured before and 2 days after surgery.Results The VAS score in resting,exercise,and contraction states in the ES group was generally better than that of the D group(P<0.05).The EPDS score of 2 days postpartum and 1month postpartum in the ES group was lower than that in the D group(P<0.05).There was no significant difference in the concentration of BDNF after surgery between the two groups(P>0.05).Conclusion Esketamine can improve postpartum depression in women after cesarean section,reduce EPDS score,and effectively relieve postoperative pain in cesarean section.