| 周 易,张秋实,马 垚,伍 林,胡 玲.艾司氯胺酮联合舒芬太尼对剖宫产围手术期镇痛、应激指标及抑郁评分的影响[J].,2022,(17):3356-3361 |
| 艾司氯胺酮联合舒芬太尼对剖宫产围手术期镇痛、应激指标及抑郁评分的影响 |
| Effects of Esketamine Combined with Sufentanil on Analgesia, Stress Indicators and Depression Score during Perioperative Period of Cesarean Section |
| 投稿时间：2022-02-18 修订日期：2022-03-14 |
| DOI：10.13241/j.cnki.pmb.2022.17.031 |
| 中文关键词: 艾司氯胺酮 舒芬太尼 剖宫产 镇痛 应激 抑郁 |
| 英文关键词: Esketamine Sufentanil Cesarean section Analgesia Stress Depression |
| 基金项目:湖北省自然科学基金面上项目（2016CFC1718） |
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| 中文摘要: |
| 摘要 目的：探究艾司氯胺酮联合舒芬太尼对剖宫产围手术期镇痛、应激指标及抑郁评分的影响。方法：选取2021年1月~2021年10月期间我院收治的行剖宫产手术的180例产妇，采用随机数字表法分为A组、B组、C组各60例。A组胎儿娩出后即刻静脉输注艾司氯胺酮，术后艾司氯胺酮联合舒芬太尼静脉自控镇痛；B组和C组胎儿娩出后不给予艾司氯胺酮，用生理盐水代替；B组术后静脉自控镇痛与A组相同，C组术后给予舒芬太尼静脉自控镇痛。比较三组产妇术后4 h（T1）、8 h（T2）、12 h（T3）、24 h（T4）、48 h（T5）疼痛程度[简化McGill疼痛问卷（SF-MPQ）评分]、镇静程度（Ramsay镇静评分），记录三组术前1 d和术后1 d的应激指标[去甲肾上腺素（NE）、皮质醇（Cor）、促肾上腺皮质激素（ACTH）]水平，比较三组术前1 d和术后3、7 d抑郁程度[爱丁堡产后抑郁量表（EPDS）]，比较三组不良反应发生情况。结果：T1、T2、T3时A组视觉模拟评分（VAS）明显低于B、C组（P均<0.05），T1、T2时A组痛分级指数（PRI）感觉分明显低于B、C组（P均<0.05），T1、T2、T3、T4、T5时A组PRI情感分明显低于B、C组（P均<0.05），T1时A组现时疼痛强度（PPI）评分明显低于B、C组（P均<0.05）。T1、T2、T3、T4、T5时，三组Ramsay镇静评分比较差异均无统计学意义（P均>0.05）。术后1 d，三组NE、Cor、ACTH水平均较术前1 d显著升高（P均<0.05），术前1 d和术后1 d，三组NE、Cor、ACTH水平比较差异均无统计学意义（P均>0.05）；术后3、7 d时A组EPDS评分明显低于术前1 d和同时间B、C组（P均<0.05）；三组不良反应发生情况对比无显著性差异（P均>0.05）。结论：艾司氯胺酮联合舒芬太尼在剖宫产围术期镇痛中应用效果良好，能够减轻产妇术后早期抑郁程度。 |
| 英文摘要: |
| ABSTRACT Objective: To explore the effects of esketamine combined with sufentanil on analgesia, stress indicators and depression score during perioperative period of cesarean section. Methods: 180 pregnant women who underwent cesarean section in our hospital from January 2021 to October 2021 were selected, and they were divided into group A, group B and group C by the random number table method, with 60 cases in each group. The group A was given intravenous infusion of esketamine immediately after fetal delivery, and postoperative esketamine combined with sufentanil for intravenous controlled analgesia. Group B and C were not given esketamine after fetal delivery, and were replaced with normal saline. Group B has the same postoperative intravenous controlled analgesia as group A, and group C was given sufentanil for postoperative intravenous controlled analgesia. The pain degree [(Short-Form McGill Pain Questionnaire (SF-MPQ)] and sedation degree (Ramsay Sedation score) of the three groups of patients were compared at 4 h (T1), 8 h (T2), 12 h (T3), 24 h (T4) and 48 h (T5) after operation. The levels of stress indicators [norepinephrine (NE), cortisol (Cor), adrenocorticotropic hormone (ACTH)] were recorded among the three groups at 1 d before operation and at 1 d after operation. The degree of depression [Edinburgh Postpartum Depression Scale (EPDS)] of the three groups was compared at 1 d before operation and 3 d and 7 d after operation, and the occurrence of adverse reactions were compared among the three groups. Results: The visual analog scale (VAS) score of group A was significantly lower than that of group B and C at T1, T2 and T3 (all P<0.05), the pain rating index (PRI) sensory score of group A was significantly lower than that of group B and C at T1 and T2 (all P<0.05), and the PRI emotional score of group A was significantly lower than that of group B and C at T1, T2, T3, T4 and T5 (all P<0.05). At T1, the current pain intensity (PPI) score of group A was significantly lower than that of group B and C (all P<0.05). At T1, T2, T3, T4 and T5, there was no significant difference in Ramsay sedation score among the three groups (all P>0.05). 1 d after operation, the levels of NE, Cor and ACTH in the three groups were significantly higher than those at 1d before operation (all P<0.05), and there were no significant differences in the levels of NE, Cor and ACTH in the three groups at 1d before operation and 1d after operation (all P>0.05). At 3 and 7 d after operation, the EPDS score of group A was significantly lower than that of group B and C at 1d before operation and at the same time (all P<0.05). There was no statistical significance in the occurrence of adverse reactions among the three groups (all P>0.05). Conclusion: Esketamine combined with sufentanil has good application effects in perioperative analgesia of cesarean section, and can relieve the early postoperative depression of pregnant women. |
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