腰硬联合麻醉加用右美托咪定在剖宫产中的镇痛效果及对产妇术后睡眠及抑郁发生风险的影响

Effect of Dexmedetomidine Combined with Spinal-Epidural Anesthesia on Analgesia,Postoperative Sleep and Incidence of Depression in Parturients with Cesarean Section

【目的】探讨剖宫产行腰硬联合麻醉(CSEA)加用右美托咪定(Dex)的镇痛效果及对产妇术后睡眠质量和抑郁发生风险的影响。【方法】70例剖宫产产妇,随机分为观察组和对照组,每组35例。对照组采取CSEA,观察组在此基础上加用Dex,比较两组镇静评分量表(Ramsay)评分、视觉模拟疼痛量表(VAS)评分,手术前后睡眠质量、抑郁评分,血流动力学及不良反应发生情况和新生儿Apgar评分。【结果】两组产妇麻醉后Ramsay评分高于麻醉即刻,术后24 h VAS评分高于术后1 h(P<0.05),且观察组麻醉后Ramsay评分高于对照组,术后24 h VAS评分低于对照组(P<0.05);两组产妇术后阿森斯失眠量表(AIS)评分高于术前,术后抑郁自评量表(SDS)评分低于术前(P<0.05),且观察组术后AIS评分、SDS评分低于对照组(P<0.05);观察组新生儿呼吸、心率、皮肤颜色评分显著高于对照组(P<0.05),两组肌张力、喉反射评分比较,差异无统计学意义(P>0.05);两组产妇术后血氧饱和度(SpO 2)水平比较,差异无统计学意义(P>0.05),心率(HR)、平均动脉压(MAP)水平显著低于术前(P<0.05),观察组术后HR、MAP水平高于对照组(P<0.05);观察组不良反应总发生率显著低于对照组(P<0.05)。【结论】剖宫产术行CSEA加用Dex镇痛、镇静效果显著,可有效减轻产妇疼痛症状,改善其睡眠质量以及抑郁情绪,值得临床推广应用。

【Objective】This study aims to explore the analgesic effects of Dexmedetomidine(Dex)combined with Spinal-Epidural Anesthesia(CSEA)on analgesia,postoperative sleep quality and risk of depression during cesarean delivery.【Methods】Seventy parturients undergoing cesarean section were randomly divided into the observation group and the control group,with 35 subjects in each group.The control group received CSEA,and the observation group received Dex in addition to CSEA.The sedation score(Ramsay),visual analog scale(VAS)for pain,preoperative and postoperative sleep quality,depression scores,hemodynamics,adverse reactions,and neonatal Apgar scores were compared between the groups.【Results】Post-anesthesia Ramsay scores in both groups were higher immediately after anesthesia;And the 24-hour postoperative VAS scores were higher than those at 1-hour post-surgery(P<0.05).The observation group showed higher post-anesthesia Ramsay scores and lower 24-hour postoperative VAS scores compared to the control group(P<0.05).Postoperative Athens Insomnia Scale(AIS)scores in both groups were higher than those preoperative scores,and postoperative Self-Rating Depression Scale(SDS)scores were lower than those preoperative scores in both groups(P<0.05),with the observation group showing lower postoperative AIS and SDS scores than the control group(P<0.05).The observation group's neonatal respiratory,heart rate,and skin color scores were significantly higher than those in the control group(P<0.05),while there were no significant differences in muscle tone and laryngeal reflex scores between the groups(P>0.05).There was no significant difference in postoperative oxygen saturation(SpO 2)levels between the groups(P>0.05),however,the heart rate(HR)and mean arterial pressure(MAP)were significantly lower postoperatively than preoperatively(P<0.05),with higher postoperative HR and MAP levels in the observation group(P<0.05).The overall incidence of adverse reactions was significantly lower in the observation group(P<0.05).【Conclusion】The use of Dex combined with CSEA for cesarean delivery significantly enhances analgesia and sedation with effectively reducing pain,improving sleep quality,and alleviating depressive symptoms,It is worthy of clinical application.