艾司氯胺酮联合纳布啡用于剖宫产术后的镇痛效果及其对产后抑郁的影响

Effect of esketamine combined with nalbuphine on postoperative analgesia after cesarean section and postpartum depression

目的探讨艾司氯胺酮联合纳布啡用于择期剖宫产术后镇痛效果,及其对产后抑郁(PPD)发生率的影响,评价联合用药的有效性和安全性。方法选择我院择期行剖宫产术的产妇60例,随机分为艾司氯胺酮+纳布啡组(EN组)和纳布啡组(N组),每组30例。所有产妇均采用腰-硬联合麻醉,术后均给予自控静脉镇痛(PCIA)。EN组镇痛方案:艾司氯胺酮0.5 mg/kg+纳布啡1.5 mg/kg,用生理盐水稀释至150 ml;N组镇痛方案:纳布啡2.0 mg/kg用生理盐水稀释至150 ml。记录两组患者术后4 h、8 h、12 h、24 h、36 h、48 h的静息、运动视觉模拟评分法(VAS)评分,记录PCIA总用量;记录产前1 d以及术后第3天、第5天、第14天、第28天爱丁堡产后抑郁量表(EPDS)得分和产后抑郁发生率;记录其他情况和不良反应。结果EN组术后8 h、12 h、24 h、36 h的静息和运动VAS评分低于N组(P<0.05),PCIA总用量少于N组(P<0.05);EN组术后第3天、第5天、第14天EPDS得分以及产后抑郁发生率低于N组(P<0.05);EN组术后首次下床活动时间、首次肛门排气时间和首次哺乳时间较N组缩短,48 h哺乳总次数增多,差异均有统计学意义(P<0.05);两组满意度和不良反应发生率比较,差异无统计学意义(P>0.05)。结论艾司氯胺酮联合纳布啡用于剖宫产术后镇痛,可明显减轻产妇静息和运动时疼痛,降低术后14 d内产后抑郁的发生率,利于产妇早期康复和母乳喂养,且无明显不良反应。

Objective To investigate the analgesic effect of esketamine combined with nalbuphine for elective cesarean section and its influence on the incidence of postpartum depression(PPD)and to evaluate the efficacy and safety.Methods Sixty full-term pregnant women undergoing elective cesarean section were enrolled in this study.They were randomly divided into esketamine+nalbuphine group(group EN)and nalbuphine group(group N),with 30 cases in each group.Combined spinal-epidural anesthesia was given in all patients,and PCIA was given after cesarean section.The analgesia regimens were as follows:esketamine 0.5 mg/kg and nalbuphine 1.5 mg/kg diluted in 150 ml of normal saline were given in group EN;nalbuphine 2.0 mg/kg diluted in 150 ml of normal saline was given in group N.VAS scores at rest and during movement were recorded aT_(4)h,8 h,12 h,24 h,36 h and 48 h after operation,and the total amount of PCIA was recorded.The Edinburgh Postnatal Depression Scale(EPDS)scores and the incidence of PPD were recorded aT_(1)d before delivery and 3,5,14 and 28 days after operation.Other conditions and adverse reactions were recorded.Results VAS scores at rest and during movement at 8 h,12 h,24 h and 36 h after operation in group EN were lower than those in group N,and the total consumption of PCIA was less than that in group N(P<0.05).EPDS scores and the incidence of PPD in group EN on the 3rd,5th and 14th day after operation were lower than those in group N(P<0.05).The time of first ambulation,first anal exhaust and first lactation in group EN were shorter than those in group N(P<0.05),and the total number of lactation in 48 h was more than that in group N(P<0.05).There was no significant difference in satisfaction or the incidence of adverse reactions between the two groups(P>0.05).Conclusion Esketamine combined with nalbuphine for analgesia after cesarean section can obviously relieve the pain of patients at rest and during movement,reduce the incidence of PPD within 14 days after operation,and is beneficial to the early rehabilitation and breastfeeding of parturients,and has no obvious adverse reaction.