艾司氯胺酮和右美托咪定改善剖宫产术产妇术后不良情绪效果的比较

Comparison of esketamine versus dexmedetomidine in improving adverse mood after cesarean section

目的比较艾司氯胺酮和右美托咪定改善剖宫产术产妇术后不良情绪的效果。方法择期行剖宫产术孕产妇114例,年龄20~45岁,BMI≤33 kg/m2,ASA分级Ⅱ或Ⅲ级,采用随机数字表法分为3组(n=38):艾司氯胺酮组(S组)、右美托咪定组(D组)和对照组(C组)。在胎儿娩出后,S组静脉注射艾司氯胺酮0.3 mg/kg,随后以0.3 mg·kg^(-1)·h^(-1)的速率静脉泵注至术毕;D组静脉注射右美托咪定0.6μg/kg,随后以0.6μg·kg^(-1)·h^(-1)的速率静脉泵注至术毕;C组静脉注射等量生理盐水,随后以14 ml/h的速率静脉泵注至术毕。术毕行PCIA,S组给予艾司氯胺酮50 mg+舒芬太尼50μg+昂丹司琼8 mg;D组给予右美托咪定200μg+舒芬太尼50μg+昂丹司琼8 mg;C组给予舒芬太尼50μg+昂丹司琼8 mg;术后48 h内VAS评分≥4分时,静脉注射氟比洛芬酯补救镇痛。分别于术前1 d、术后2和7 d时行焦虑自评量表(SAS)评分和爱丁堡产后抑郁量表(EPDS)评分;分别于术前1 d和术后2 d时采用ELISA法测定血清脑源性神经营养因子(BDNF)浓度;记录术后镇痛泵有效按压次数和补救镇痛情况;记录术中及术后48 h内不良反应发生情况。结果与C组比较,S组和D组术后2和7 d时SAS评分和EPDS评分降低,术后2 d时血清BDNF浓度升高,镇痛泵有效按压次数减少,补救镇痛率降低,术中恶心和呕吐发生率降低(P<0.05);与D组比较,S组术后7 d时SAS评分和EPDS评分降低,镇痛泵有效按压次数减少(P<0.05),术后2 d时血清BNDF浓度和补救镇痛率差异无统计学意义(P>0.05)。与C组和D组比较,S组术中多梦发生率升高(P<0.05)。结论艾司氯胺酮改善剖宫产术产妇术后不良情绪的效果优于右美托咪定。

Objective To compare esketamine versus dexmedetomidine in improving the adverse mood after cesarean section.Methods One hundred and fourteen pregnant women undergoing elective cesarean section,aged 20-45 yr,with body mass index≤33 kg/m2,of American Society of Anesthesiologists Physical Status classificationⅡorⅢ,were divided into 3 groups(n=38 each)by the random number table method:esketamine group(group S),dexmedetomidine group(group D)and control group(group C).After delivery,esketamine was intravenously injected as a bolus of 0.3 mg/kg,followed by an infusion of 0.3 mg·kg^(-1)·h^(-1)throughout the surgery in group S,dexmedetomidine was intravenously injected as a bolus of 0.6μg/kg,followed by an infusion of 0.6μg·kg-1·h-1 throughout the surgery in group D,while the equal volume of normal saline was given instead,followed by an infusion of 14 ml/h throughout the surgery in group C.Patient-controlled intravenous analgesia was performed after the end of surgery.Esketamine 50 mg,sufentanil 50μg and ondansetron 8 mg were given in group S,dexmedetomidine 200μg,sufentanil 50μg and ondansetron 8 mg were given in group D,while sufentanil 50μg and ondansetron 8 mg were given in group C.When the visual analog scale score≥4 within 48 h after operation,flurbiprofen axidate was intravenously injected as a rescue analgesic.Self-rating Anxiety Scale(SAS)scores and Edinburgh Postnatal Depression Scale(EPDS)scores were assessed at 1 day before surgery and 2 and 7 days after surgery.Serum levels of brain-derived neurotrophic factor(BDNF)were measured by enzyme-linked immunosorbent assay at 1 day before surgery and 2 days after surgery.The effective pressing times of patient-controlled analgesia(PCA)and requirement for rescue analgesia after operation were recorded.The occurrence of adverse reactions during operation and within 48 h after operation was also recorded.Results Compared with group C,SAS scores and EPDS scores were significantly decreased at 2 and 7 days after surgery,serum BDNF concentrations were increased at 2 days after surgery,the effective pressing times of PCA were reduced,the requirement for rescue analgesia was decreased,and the incidence of intraoperative nausea and vomiting was reduced in S and D groups(P<0.05).Compared with group D,SAS scores and EPDS scores were significantly decreased at 7 days after surgery,the effective pressing times of PCA were reduced(P<0.05),and no significant change was found in serum BDNF concentrations at 2 days after surgery and requirement for rescue analgesia in group S(P>0.05).The incidence of dreaminess was significantly higher in group S than in group C and group D(P<0.05).Conclusions Esketamine is better than dexmedetomidine in improving the adverse mood after cesarean section.