剖宫产术后镇痛应用艾司氯胺酮在产后抑郁中的临床作用研究

Study on the clinical effect of esketamine for postoperative analgesia after cesareansection in postpartum depression

目的研究剖宫产术后镇痛应用艾司氯胺酮在产后抑郁中的临床作用。方法选取2021年6月—2022年10月在永州市中心医院接受剖宫产术的240例产妇,采用随机数字表法分为观察组(120例)和对照组(120例)。观察组采用艾司氯胺酮进行术后镇痛,对照组采用氢吗啡酮镇痛。比较两组产妇术前,术后2 d、5 d爱丁堡产后抑郁自评量表评分(EPDS)及总体、平躺时、坐立时、站立时、行走时疼痛视觉模拟评分(VAS)(分别记为VAS总、VAS平、VAS坐、VAS站、VAS行)。84例产妇符合产后抑郁诊断标准,分为艾司氯胺酮组44例,非艾司氯胺酮组40例。结果观察组术后2 d VAS总、VAS平、VAS坐、VAS站、VAS行评分分别为(3.64±2.80)分、(2.99±2.40)分、(3.45±2.47)分、(3.51±2.63)分、(3.73±2.67)分,较对照组的(4.73±2.46)分、(4.28±2.39)分、(4.89±2.43)分、(5.00±2.58)分、(5.08±2.58)分均明显降低(均P<0.05)。观察组术后5 d VAS总、VAS平、VAS坐、VAS站、VAS行评分分别为(2.27±1.97)分、(1.48±1.64)分、(1.85±1.64)分、(2.01±1.67)分、(2.10±1.69)分,较对照组的(2.88±1.72)分、(2.20±1.64)分、(2.82±1.79)分、(2.93±1.72)分、(3.07±1.70)分均明显降低(均P<0.05)。观察组术后2 d、5 d EPDS评分分别为(6.18±4.19)分、(5.64±4.10)分,较对照组的(7.48±4.61)分、(7.10±4.75)分均明显降低(均P<0.05)。剖宫产术后1个月,艾司氯胺酮组EPDS评分为(7.09±3.19)分,较非艾司氯胺酮组的(9.50±4.97)分明显降低(Z=2.616,P<0.05)。结论剖宫产术后应用艾司氯胺酮镇痛在产后抑郁中有一定临床效用。

Objective To investigate the clinical effect of esketamine for postoperative analgesia after cesarean section in postpartum depression.Methods A total of 240 cases of parturients who underwent cesarean section in Yongzhou Central Hospital were selected from June 2021 to October 2022,then the parturients were divided into observation group(120 cases)and control group(120 cases)according to random number table method.Esketamine was used for postoperative analgesia in observation group,and the control group was treated with hydromorphone for analgesia.The scores of Edinburgh Postnatal Depression Scale(EPDS)and visual analog scale(VAS)(VAS total,VAS flat,VAS sitting,VAS standing,VAS row)before operation,2 days after operation,and 5 days after operation were compared.A total of 84 parturients met the diagnostic criteria of postpartum depression,then they were divided into esketamine group(44 cases)and non-esketamine group(40 cases).Results At 2 days after operation,VAS total,VAS flat,VAS sitting,VAS standing,VAS row in observation group were(3.64±2.80),(2.99±2.40),(3.45±2.47),(3.51±2.63),and(3.73±2.67),respectively,which were lower than those in control group[(4.73±2.46),(4.28±2.39),(4.89±2.43),(5.00±2.58),and(5.08±2.58)],there were statistically significant differences(all P<0.05).At 5 days after operation,VAS total,VAS flat,VAS siing,VAS standing,VAS row in observation group were(2.27±1.97),(1.48±1.64),(1.85±1.64),(2.01±1.67),and(2.10±1.69),respectively,which were lower than those in control group[(2.88±1.72),(2.20±1.64),(2.82±1.79),(2.93±1.72),and(3.07±1.70)],there were statistically significant differences(all P<0.05).At one month after cesarean section,EPDS score in esketamine group was(7.09±3.19),which was lower than that in non-esketamine group(9.50±4.97),there was statistically significant difference(Z=2.616,P<0.05).Conclusion The application of esketamine for analgesia during cesarean section has a certain impact on improving postpartum depression.