摘要
目的研究不同剂量艾司氯胺酮对于剖宫产产妇术后抑郁影响的临床观察。方法选取2022年4月至11月于西安国际医学中心医院行剖宫产手术的156例患者为研究对象,随机分为3组,新生儿娩出后断开脐带即刻,静脉注射干预药物。A组:艾司氯胺酮0.125mg/kg;B组:艾司氯胺酮0.25mg/kg;C组:生理盐水。三组术后应用相同配方静脉镇痛泵。观察产妇术后爱丁堡抑郁评分(EPDS)下降率、匹茨堡睡眠质量评分(PSQI)、术后镇痛情况及不良反应。结果与术前1天相比,A组和B组产妇术后5天、7天、14天、30天和42天EPDS评分均显著下降(F值分别为15.63、25.28,P<0.05),C组产妇术后14天、30天和42天EPDS评分均显著下降(F=31.99,P<0.05);A组和B组产妇术后3天、5天、7天的EPDS评分下降率高于C组(F值分别为10.75、11.84、19.56,P<0.05);三组产妇术后14天、30天和42天PSQI评分较术前相比均显著降低(F值分别为22.94、14.29、14.03,P<0.05);B组产妇术后3天和5天PSQI评分较C组显著降低(F值分别为6.08、4.44,P<0.05);三组产妇术后镇痛情况无显著性差异(P>0.05),B组不良反应发生率最高(χ^(2)值介于6.12~21.94之间,P<0.05)。结论术中静脉单次注射0.125mg/kg和0.25mg/kg艾司氯胺酮,均可以改善产妇术后EPDS评分,预防产后抑郁发生。0.25mg/kg艾司氯胺酮可以更好地帮助改善产妇术后睡眠质量,但也增加了艾司氯胺酮引起的副作用。
Objective To investigate the effects of different doses of esketamine on postpartum depression in women who underwent cesarean section.Methods 156 women who had cesarean section at Xi'an International Medical Center Hospital from April 2022 to November 2022 were enrolled and randomly assigned to three groups,with intravenous interventions injected immediately after delivery of the newborns by disconnecting the umbilical cord.Group A:esketamine 0.125mg/kg;Group B:esketamine 0.25mg/kg;Group C:normal saline.The same postoperative formula of intravenous analgesic pump was used in all three groups.The rate of decrease in Edinburgh Postnatal Depression Scale(EPDS),Pittsburgh Sleep Quality Index(PSQI),postoperative pain relief and adverse reactions were observed.Results Compared with one day before surgery,EPDS scores in group A and B decreased significantly on postoperative days 5,7,14,30 and 42(F=15.63 and 25.28,respectively,P<0.05),while EPDS scores in group C decreased significantly on postoperative days 14,30 and 42(F=31.99,P<0.05);EPDS score reduction rates in group A and B on postoperative days 3,5 and 7 days were higher than those in group C(F=10.75,11.84 and 19.56,respectively,P<0.05);PSQI scores in all groups on postoperative days 14,30 and 42 were significantly lower than those before surgery(F=22.94,14.29 and 14.03,respectively,P<0.05);PSQI scores in group B on postoperative days 3 and 5 were significantly lower than those in group C(F=6.08 and 4.44,respectively,P<0.05);There was no significant difference in postoperative pain relief among three groups(P>0.05),but group B had the highest rate of adverse reactions(χ^(2)=6.12-21.94,P<0.05).Conclusion Single intravenous injection of esketamine at doses of 0.125mg/kg and o.25mg/kg during surgery can reduce EPDS scores after surgery and prevent postpartum depression in women who had cesarean section.Esketamine at a dose of 0.25mg/kg can also improve sleep quality after surgery for these women,but it may increase the risk of esketamine-related side effects.
作者
商燕
李思远
郑琴
米婷婷
梁静
王彬荣
SHANG Yan;LI Siyuan;ZHENG Qin;MI Tingting;LIANG Jing;WANG Binrong(Anesthesia Surgery Center,Xi'an International Medical Center Hospital,Shaanxi Xi'an 710100,China)
出处
《中国妇幼健康研究》
2023年第9期28-34,共7页
Chinese Journal of Woman and Child Health Research
基金
陕西省重点研发计划项目(2022SF-487)
西安国际医学中心医院院级课题(2022MS14)
西安国际医学中心医院新技术项目(20211205)。
关键词
艾司氯胺酮
剖宫产产妇
产后抑郁
爱丁堡抑郁评分
esketamine
postpartum depression
cesarean section
Edinburgh Postnatal Depression Scale(EPDS
