全麻剖宫产术中使用艾司氯胺酮对麻醉效果和产后抑郁症影响的观察

Effects of esketamine use for caesarean section under general anesthesia on anesthesia and postpartum depression

目的观察和评价全麻剖宫产术中使用艾司氯胺酮对麻醉效果和产后抑郁症(PPD)的影响。方法选择120例择期行全麻剖宫产术的足月初产妇,采用随机数字表法分为3组(每组40例):艾司氯胺酮复合丙泊酚连续泵注组(CEP组)、艾司氯胺酮单次静脉推注复合丙泊酚连续泵注组(BEP组)和七氟醚吸入维持组(S组)。胎儿娩出后,CEP组连续泵注艾司氯胺酮和丙泊酚,BEP组单次静脉推注艾司氯胺酮和连续泵注丙泊酚,S组采用七氟醚吸入维持麻醉。记录3组产妇入手术室时(T_(1))、麻醉诱导后(T_(2))、胎儿娩出时(T_(3))、手术结束时(T_(4))和清醒出手术室时(T_(5))的心率、收缩压和舒张压,术后清醒时(静息状态和活动状态)、术后12 h、术后24 h、术后48 h的视觉模拟评分法(VAS)疼痛评分,苏醒时间,术后恶心呕吐、头晕、精神症状等不良反应发生情况,术前、术后3 d、术后42 d的爱丁堡产后抑郁量表(EPDS)评分和PPD发生情况;记录CEP组和BEP组术中艾司氯胺酮总用量。结果与S组比较,CEP组和BEP组T_(3)、T_(4)、T_(5)时心率、收缩压和舒张压较高(均P<0.05),术后清醒时(静息状态和活动状态)、术后12 h及术后24 h VAS疼痛评分较低(均P<0.05),苏醒时间较短(均P<0.05),术后3 d和术后42 d EPDS评分和PPD发生率较低(均P<0.05);T_(1)、T_(2)时心率、收缩压和舒张压,术后48 h VAS疼痛评分,术前EPDS评分、PPD发生率,术后恶心呕吐、头晕、精神症状等不良反应发生率差异无统计学意义(均P>0.05)。与BEP组比较,CEP组术后清醒时静息状态VAS疼痛评分较低(P<0.05),各时点心率、收缩压、舒张压,苏醒时间,术后EPDS评分、PPD发生率差异无统计学意义(均P>0.05)。结论全麻剖宫产术中应用艾司氯胺酮可以更好地维持产妇术中生命体征平稳,苏醒时间短,苏醒时疼痛感减少;还可有效抑制产后抑郁,降低PPD发生率。

Objective To observe and evaluate the effect of esketamine use for cesarean section under general anesthesia on anesthesia and postpartum depression(PPD).Methods A total of 120 full-term primigravid women who underwent elective caesarean section under general anesthesia were selected.According to the random number table method,the women were divided into three groups(n=40):a continuous infusion of esketamine combined with propofol group(CEP group),a single intravenous bolus of esketamine combined with propofol continuous infusion group(BEP group),and a sevoflurane inhalation maintenance group(S group).After delivery of the fetus,the CEP group was continuously infused by pump with esketamine and propofol,the BEP group was subject to single intravenous bolus of esketamine and continuous infusion by pump of propofol,and the S group inhaled with sevoflurane for anesthesia maintenance.Their heart rate,systolic blood pressure and diastolic blood pressure at the time of admission to the operating room(T_(1)),after anesthesia induction(T_(2)),after delivery of the fetus(T_(3)),at the end of the operation(T_(4)),and at the time of recovery and leaving the operating room(T_(5));Visual Analogue Scale(VAS)scores during recovery after the operation(the resting state and active state),at postoperative 12 h,24 h and 48 h;recovery time,postoperative nausea and vomiting,dizziness,and mental symptoms were recorded.The Edinburgh Postnatal Depression Scale(EPDS)scores and the incidence of PPD before surgery,at postoperative 3 days and 42 days were recorded.The total intraoperative dosages of esketamine in both the CEP and BEP groups were recorded.Results Compared with the S group,the CEP and BEP groups showed increases in heart rate,systolic blood pressure and diastolic blood pressure at T_(3),T_(4) and T_(5)(all P<0.05),decreases in VAS scores during recovery after the operation(the resting state and active state),at postoperative 12 h and 24 h(all P<0.05),and shortened recovery time(all P<0.05),and decreases in EPDS scores at postoperative 3 days and 42 days and the incidence of PPD(both P<0.05).No statistical difference was found in the heart rate,systolic and diastolic blood pressure at T_(1) and T_(2),VAS score at postoperative 48 h,preoperative EPDS score,PPD incidence,and the incidences of nausea and vomiting,dizziness,and mental symptoms(all P>0.05).Compared with the BEP group,the CEP group presented decreases in resting state VAS scores during recovery after surgery(P<0.05),and there was no statistical differences in heart rate,systolic blood pressure,diastolic blood pressure,recovery time,EPDS score,PPD incidence(all P>0.05).Conclusions Application of esketamine for cesarean section under general anesthesia can better maintain stable intraoperative vital signs,with fast recovery time and little pain at recovery.It can also effectively inhibit postpartum depression and reduce the incidence of PPD.