2021 年第 12 期 第 16 卷

小剂量艾司氯胺酮复合舒芬太尼用于剖宫产术后自控静脉镇痛的效果

Effects of low-dose esketamine combined with sufentanil on patient-controlled intravenous analgesia after cesarean section

作者：郭杰杨春云田静

英文作者：Guo Jie Yang Chunyun Tian Jing

单位：湖北省恩施土家族苗族自治州中心医院药剂科445000

英文单位：Department of Pharmacy the Central Hospital of Enshi Tujia and Miao Autonomous Prefecture Hubei Province Enshi 445000 China

关键词：剖宫产；术后镇痛；自控静脉镇痛；艾司氯胺酮；舒芬太尼

英文关键词：Cesareansection;Postoperativeanalgesia;Patient-controlledintravenousanalgesia;Esketamine;Sufentanil

• 摘要：

• 目的 探讨小剂量艾司氯胺酮复合舒芬太尼用于剖宫产术后自控静脉镇痛（PCIA）的效果。方法 选取2019年9—12月于湖北省恩施土家族苗族自治州中心医院拟行剖宫产手术的产妇168例作为研究对象，采用随机数字表法分为S1组、S2组和S3组，各56例。3组均于术后行PCIA，S1组：舒芬太尼100 μg+昂丹司琼8 mg，S2组：舒芬太尼150 μg+昂丹司琼8 mg，S3组：舒芬太尼100 μg+艾司氯胺酮50 mg+昂丹司琼8 mg。比较各组术后镇痛镇静情况，评估产妇产后抑郁情况、抑郁相关激素水平，记录PCIA按压次数和用药不良反应。结果  S1组术后4 h疼痛视觉模拟量表（VAS）评分高于术毕，且高于S2组和S3组；术后24 h，3组VAS评分均低于术毕、术后4 h，且S3组均低于S1组和S2组［（2.3±0.5）分比（2.7±0.6）、（2.5±0.4）分］（均P＜0.05）。3组术后4、24 h Ramsay镇静评分低于本组术毕（均P＜0.05），但3组间比较差异均无统计学意义（均P＞0.05）。术后1周，S3组爱丁堡产后抑郁量表（EPDS）评分均低于S1组和S2组；术后4周，3组EPDS评分均高于术后1周，但S3组低于S1组和S2组（均P＜0.05）。术后48 h，3组去甲肾上腺素、脑源性神经营养因子水平均低于术毕，但S3组均高于S1组和S2组（均P＜0.05）。S2组和S3组PCIA按压次数少于S1组［（5.0±1.1）、（4.5±1.8）次比（7.1±1.3）次］（P＜0.001），3组不良反应发生率比较差异无统计学意义（P＞0.05）。结论  小剂量艾司氯胺酮复合舒芬太尼用于剖宫产术后镇痛效果良好，安全性较高，且能有效缓解产后短期抑郁情绪。

• Objective To investigate the effects of low-dose esketamine combined with sufentanil on patient-controlled intravenous analgesia (PCIA) after cesarean section. Methods From September to December 2019, 168 puerpera who were planning to undergo cesarean section in the Central Hospital of Enshi Tujia and Miao Autonomous Prefecture, Hubei Province were selected. The patients were randomly divided into S1 group, S2 group and S3 group, with 56 cases in each group. All the groups received PCIA after surgery, S1 group was given sufentanil 100 μg+ondansetron 8 mg, S2 group was given sufentanil 150 μg+ondansetron 8 mg, and S3 group was given sufentanil 100 μg+esketamine 50 mg+ondansetron 8 mg. The postoperative analgesia and sedation of each group were compared among the three groups, the postpartum depression and levels of depression-related hormones were evaluated, and the frequency of PCIA compressions and adverse drug reactions were recorded. Results At 4 h after surgery, pain visual analogue scale (VAS) score in S1 group was higher than that at the end of surgery, and was higher than that in S2 group and S3 group; at 24 h after surgery, VAS score in the three groups was lower than that at the end of surgery and 4 h after surgery, and that in S3 group was lower than that in S1 group and S2 group［（2.3±0.5） vs （2.7±0.6）,（2.5±0.4）］（all P＜0.05）. At 4 and 24 h after surgery, Ramsay sedation score in the three groups was lower than that at the end of surgery (all P<0.05), but there was no statistically significant difference in the Ramsay sedation score among the groups (both P>0.05). One week after surgery, the Edinburgh Postnatal Depression Scale (EPDS) score in S3 group was lower than that in S1 group and S2 group; 4 weeks after surgery, EPDS score in the three groups were higher than that 1 week after surgery, but that in S3 group was lower than that in S1 group and S2 group (all P<0.05). At 48 h after surgery, levels of norepinephrine and brain-derived neurotrophic factor in the three groups were lower than those at the end of surgery, but those in S3 group were higher than those in S1 group and S2 group (all P<0.05). The frequency of PCIA compressions in S2 group and S3 group was lower than that in S1 group［（5.0±1.1）,（4.5±1.8）times vs （7.1±1.3）times］（P＜0.001）. There was no significant difference in the incidence of adverse reactions among the three groups (P>0.05). Conclusion  Low-dose esketamine combined with sufentanil has a good analgesic effect and high safety after cesarean section, and it can effectively relieve the short-term postpartum depression.