不同剂量艾司氯胺酮对剖宫产术后产妇抑郁及疼痛程度的影响

Effect of Different Doses of Esmketamine on Postpartum Depression and Pain Level After Cesarean Section

目的探讨不同剂量艾司氯胺酮对剖宫产术后产妇抑郁及疼痛程度的影响。方法选取青岛大学附属山东省妇幼保健院2021年10月至2022年10月收治的行剖宫产产妇330例,按随机数字表法分为对照组、低剂量组、高剂量组,各110例。剖宫产术毕,行患者自控镇痛(PCIA)。3组产妇均予舒芬太尼50μg+酒石酸布托啡诺10 mg+昂丹司琼8 mg方案,低剂量组产妇加用艾司氯胺酮0.6 mg/kg,高剂量组产妇加用艾司氯胺酮1.2 mg/kg,均用0.9%氯化钠注射液稀释至100 mL。结果与对照组比较,低剂量组和高剂量组产妇术后3 d和7 d的爱丁堡产后抑郁量表(EPDS)评分均显著降低(P<0.05),产妇术后4 h、12 h、24 h、48 h静息和活动时的视觉模拟评分法(VAS)评分均显著降低(P<0.05),且高剂量组产妇降低更显著(P<0.05)。高剂量组、低剂量组、对照组产妇术后3 d和7 d的产后抑郁发生率的差异显著(4.55%比8.18%比14.55%,6.36%比10.91%比18.18%,P<0.05);不良反应发生率相当(P>0.05)。结论高剂量艾司氯胺酮可有效降低剖宫产产妇的产后抑郁评分及抑郁发生率,改善剖宫产术后的疼痛程度,且安全性良好。

Objective To investigate the effects of different doses of esketamine on postpartum depression(PPD)and pain level after cesarean section.Methods A total of 330 postpartum women who underwent cesarean section in the Shandong Provincial Maternal and Child Health Care Hospital Affiliated to Qingdao University from October 2021 to October 2022 were selected and divided into the control group,the low-dose group,and the high-dose group by the random number table method,with 110 cases in each group.After cesarean section,patient-controlled intravenous analgesia(PCIA)was performed.The three groups were given the regimen of sufentanil(50μg),butorphanol tartrate(10 mg),and ondansetron(8 mg),on this basis,the low-dose group was given 0.6 mg/kg of esketamine,while the high-dose group was given 1.2 mg/kg of esketamine,and the drugs in the three groups were diluted to 100 mL with 0.9%Sodium Chloride Injection.Results Compared with those in the control group,the Edinburgh Postnatal Depression Scale(EPDS)scores in the low-dose and high-dose groups significantly reduced at 3 d and 7 d after surgery(P<0.05),the visual analogue scale(VAS)scores at rest and activity significantly reduced at 4 h,12 h,24 h,and 48 h after surgery(P<0.05),and those in the high-dose group were significantly lower than those in the low-dose group(P<0.05).There was a significant difference in the incidence of PPD among the high-dose group,low-dose group,and control group at 3 d and 7 d after surgery(4.55%vs.8.18%vs.14.55%,6.36%vs.10.91%vs.18.18%,P<0.05).The incidence of adverse reactions among the three groups was comparable(P>0.05).Conclusion High-dose esketamine can effectively reduce the PPD score and incidence of depression after cesarean section,alleviate the degree of pain after cesarean section,and it has good safety.