摘要
目的评价艾司氯胺酮PCIA对剖宫产术孕产妇产后抑郁症的影响。方法选择择期椎管内麻醉下行剖宫产术的孕产妇300例,年龄25~35岁,BMI≤35 kg/m^(2),ASA分级Ⅰ或Ⅱ级,依照随机数字表法分为2组(n=150):对照组(C组)和艾司氯胺酮(E组)。术毕行PCIA,C组药物配方:枸橼酸舒芬太尼50μg+酒石酸布托啡诺12 mg+胃复安针20 mg,E组药物配方:艾司氯胺酮1 mg/kg+枸橼酸舒芬太尼50μg+酒石酸布托啡诺12 mg+胃复安针20 mg,2组用0.9%生理盐水稀释至200 ml,背景输注速率4 ml/h,PCA剂量4 ml,锁定时间30 min,镇痛至术后48 h,维持VAS评分<4分。若VAS评分≥4分且患者连续按压PCA泵按钮2次无效时,口服对乙酰氨基酚0.5 g补救镇痛。分别于术前1 d和术后3、7、42 d时行爱丁堡产后抑郁量表(EPDS)评分。EPDS评分≥10分为轻度抑郁症,EPDS评分≥13分为重度抑郁症,排除产前抑郁症的孕产妇。记录产后抑郁症发生情况和程度。记录术后0~6 h、6~12 h、12~24 h和24~48 h内补救镇痛情况及术后3 d内相关不良反应的发生情况。结果与C组比较,E组术后3和7 d时产后抑郁症发生率降低且程度减轻,术后不同时段补救镇痛率降低(P<0.05),相关不良反应发生率比较差异无统计学意义(P>0.05)。结论艾司氯胺酮用于剖宫产术后PCIA,在产生良好镇痛效应的同时,还可改善孕产妇产后抑郁症。
Objective To evaluate the effects of patient-controlled intravenous analgesia(PCIA)with esketamine on postpartum depression(PPD)in puerpera undergoing cesarean section.Methods A total of 300 American Society of Anesthesiologists physical statusⅠorⅡpatients,aged 25-35 yr,with body mass index≤35 kg/m^(2),scheduled for elective cesarean section under spinal anesthesia,were divided into 2 groups(n=150 each)by a random number table method:control group(group C)and esketamine group(group E).PCIA was performed at the end of surgery.In group C,the PCIA solution contained sufentanil citrate 50μg,butorphanol tartrate 12 mg and metoclopramide injection 20 mg in 200 ml of 0.9%normal saline.In group E,the PCIA solution contained esketamine 1 mg/kg,sufentanil citrate 50μg,butorphanol tartrate 12 mg and metoclopramide injection 20 mg in 200 ml of 0.9%normal saline.The PCA pump was set to deliver a background infusion of 4 ml/h and a bolus dose of 4 ml at 30 min lockout interval.The analgesia lasted for 48 h after surgery,and the visual analog scale(VAS)score was maintained<4 points.Acetaminophen 0.5 g was administered orally as a rescue analgesic when VAS score≥4 points and pain was still unrelieved after PCA pump was pressed twice in a row.The Edinburgh Postnatal Depression Scale(EPDS)was performed at 1 day before and at 3,7 and 42 days after surgery.Depression was classified on EPDS as mild(score≥10)and severe(score≥13).The patients with preoperative depression were excluded from the study.The occurrence and degree of depression were recorded.The requirement for rescue analgesia within 0-6 h,6-12 h,12-24 h and 24-48 h after surgery and development of adverse effects within 3 days after surgery were recorded.Results Compared with group C,the incidence of PPD was significantly decreased and degree was reduced at 3 and 7 days after surgery,incidence of rescue analgesia was decreased in different time periods(P<0.05),and no significant change was found in the incidence of adverse effects in group E(P>0.05).Conclusio
作者
顾盼
姜秀丽
杜伯祥
姚雷
宋杰
Gu Pan;Jiang Xiuli;Du Boxiang;Yao Lei;Song Jie(Department of Anesthesiology,Nantong First People′s Hospital,Nangtong 226001,China)
出处
《中华麻醉学杂志》
CAS
CSCD
北大核心
2021年第3期274-277,共4页
Chinese Journal of Anesthesiology
基金
南通市卫生和计划生育委员会科研课题计划资助项目(WKZL2018018)。
关键词
氯胺酮
镇痛
病人控制
剖宫产术
抑郁症
产后
Ketamine
Analgesia,patient-controlled
Cesarean section
Depression,postpartum
