亚麻醉剂量艾司氯胺酮对剖宫产患者术后痛觉过敏及产后抑郁的影响

Effect of subanesthetic dose of esketamine on postoperative hyperalgesia andpostpartum depression in patients undergoing caesarean section

目的探讨亚麻醉剂量艾司氯胺酮对全身麻醉剖宫产术后瑞芬太尼诱导的痛觉过敏的影响,并观察其对血清同型半胱氨酸(Hcy)水平及产后抑郁的影响。方法选取择期行全身麻醉剖宫产的产妇50例,按照随机数字表法将其分为艾司氯胺酮组和对照组(每组25例)。两组分别在胎儿娩出后10 min给予艾司氯胺酮0.2 mg/kg、等量生理盐水缓慢注射。比较两组拔管时间、术后2 h内视觉模拟评分(VAS)得分及麻醉后监测治疗室(PACU)吗啡用量;比较两组术前1 d、术后1 d、术后4 d及术后1个月患者爱丁堡产后抑郁量表(EPDS)评分;检测两组术前1 d、术后1 d及术后4 d血清Hcy水平。结果两组患者术后拔管时间差异无统计学意义(P>0.05);与对照组相比,艾司氯胺酮组首次出现VAS≥4分的时间延长,而从注射吗啡至VAS<4分所需时间缩短(P<0.05);艾司氯胺酮组PACU吗啡使用量低于对照组(P<0.05)。与对照组相比,艾司氯胺酮组术后15 min、30 min、45 min、1 h、90 min VAS评分均降低(P<0.05),而术后2 h两组患者VAS评分比较差异无统计学意义(P>0.05)。艾司氯胺酮组术后1 d和术后4 d EPDS评分低于对照组(P<0.05),而两组患者术后1个月EPDS评分差异无统计学意义(P>0.05)。艾司氯胺酮组术后1 d和术后4 d血清Hcy水平均低于对照组(P<0.05)。结论全身麻醉剖宫产术中注射亚麻醉剂量艾司氯胺酮能有效缓解瑞芬太尼诱导的痛觉过敏,并预防产后抑郁的发生。

Objective To investigate the effect of subanesthetic dose of esketamine on remifentanil-induced hyperalgesia after cesarean section under general anesthesia,and its effect on serum homocysteine(Hcy)level and postpartum depression.Methods A total of fifty patients undergoing cesarean section under general anesthesia were randomly divided into the esketamine group and the control group(25 cases in each group).The two groups were given esketamine 0.2 mg/kg and the same amount of normal saline by slow injection 10 min after fetal delivery.Then,the extubation time,visual analogue scale(VAS)score within two hours after operation,and consumption of morphine while in the post-anaesthesia care unit(PACU)were compared between the two groups.The Edinburgh Postnatal Depression Scale(EPDS)scores were compared at one day before surgery,one day,four days,and one month after surgery.Serum Hcy levels were measured at one day before surgery,one day and four days after surgery.Results There was no significant difference in extubation time between the two groups(P>0.05).Compared with the control group,it took a longer time for patients in the esketamine group to have a VAS score≥4 for the first time,but the time from morphine injection to a VAS score<4 was shortened(P<0.05).The amount of morphine used in the esketamine group was lower than that in the control group in PACU(P<0.05).Compared with the control group,the VAS scores of the esketamine group decreased at 15 min,30 min,45 min,one hour,and 90 min after surgery(P<0.05),while there was no statistical significance difference in VAS scores at two hours after surgery(P<0.05).EPDS scores in the esketamine group were lower than those in the control group at one day and four days after surgery(P>0.05),but there was no statistically significant between the two groups at one month after surgery(P>0.05).Serum Hcy level in the esketamine group was lower than that in the control group at one day and four days after surgery(P<0.05).Conclusion The subanesthetic dose of esketamine during caesarean section under general anesthesia can effectively relieve remifentanil-induced postoperative hyperalgesia and prevent the occurrence of postpartum depression.