【罂粟摘要】艾司氯胺酮对剖宫产术后镇痛和产后抑郁的影响：一项随机、双盲对照试验

艾司氯胺酮对剖宫产术后镇痛和产后抑郁的影响：一项随机、双盲对照试验

贵州医科大学 麻醉与心脏电生理课题组

翻译：宋雨婷     

编辑：宋雨婷 

审校：曹莹

背景：

这项随机双盲安慰剂对照临床试验的目的是研究不同剂量艾司氯胺酮联合舒芬太尼用于剖宫产术后静脉自控镇痛的效果和产后抑郁症的发生率。

方法：

本试验纳入160名单胎足月妊娠且美国麻醉医师协会健康状态分级为II级且拟行择期剖宫产患者。所有患者均在腰-硬联合阻滞下完成麻醉。根据患者静脉自控镇痛的药物配方随机分为4组。记录剖宫产术后48小时舒芬太尼的使用情况，有效按压次数以及补救镇痛次数，术后1周和6周产后抑郁症（PPD）的发生率。

结果：

舒芬太尼累计使用剂量、术后48小时有效按压次数和补救镇痛次数比较：H组显著低于M组、L组和C组（P < 0.05），M组显著低于L组和C组（P< 0.05），L组显著低于C组（P <0.05）。1周后和6周后PPD发病率比较：H组显著低于M组、L组和C组（P <0.01），M组显著低于L组和C组（P <0.01），L组显著低于C组（P <0.01）。与C组相比，H组、M组和L组恶心呕吐发生率显著降低（P< 0.05）。（C组： 舒芬太尼 1.5μg/kg+托烷司琼 4mg+生理盐水稀释至150mL；L组：舒芬太尼 1.5μg/kg+托烷司琼4mg+艾司氯胺酮 0.1mg/kg+生理盐水稀释至150mL；M组：舒芬太尼 1.5μg/kg+托烷司琼 4mg+艾司氯胺酮0.2mg/kg+生理盐水稀释至150mL；H组：舒芬太尼 1.5μg/kg+托烷司琼 4mg+艾司氯胺酮 0.4mg/kg+生理盐水稀释至150mL）

结论：

艾司氯胺酮联合舒芬太尼用于择期剖宫产术后患者静脉自控镇痛，可减少舒芬太尼的用量，改善术后镇痛，降低术后1周、6周PPD发生率和术后恶心呕吐的发生率。

原始文献来源：

Wang W, Xu H, Ling B, Chen Q, Lv J, Yu W. Effects of esketamine on analgesia and postpartum depression after cesarean section: A randomized, double-blinded controlled trial. Medicine (Baltimore). 2022;101(47):e32010.

英文原文

Effects of esketamine on analgesia and postpartum depression after cesarean section: A randomized, double-blinded controlled trial

Background: The aim of this randomized double-blind placebo controlled clinical trial was to investigate the effects of different doses of esketamine combined with sufentanil for postoperative intravenous controlled analgesia after cesarean section and the incidence of postpartum depression.

Methods: One hundred and sixty patients undergoing elective cesarean section, with a singleton term pregnancy and American Society of Anesthesiologists physical status II were selected. All patients were treated by a combined epidural with spinal anesthesia. They were randomly divided into 4 groups according to patient controlled intravenous analgesia formula. The consumption of sufentanil, times of effective press and remediate analgesia at 48 hours after cesarean section, incidence of postpartum depression (PPD) at 1 week and 6 weeks after the operation were recorded.

Results: Comparison of cumulated dosage of sufentanil, times of effective press and rescue analgesia at 48 hours after operation: Group H was significantly lower than Group M, Group L, and Group C (P < .05), Group M significantly lower than group L and Group C (P < .05), and Group L significantly lower than Group C (P < .05). Comparison of the incidence of PPD at 1 week and 6 weeks later: Group H was significantly lower than Group M, Group L, and Group C (P < .01), Group M significantly lower than Group L and Group C (P < .01) and Group L significantly lower than Group C (P < .01). Compared with Group C, the incidence of nausea and vomiting was significantly reduced in Group H, Group M, and Group L (P < .05).

Conclusion: Esketamine combined with sufentanil used for patient controlled intravenous analgesia after elective cesarean section can reduce the consumption of sufentanil, improve postoperative analgesia, decrease the incidence of PPD at 1 week and 6 weeks and postoperative nausea and vomiting.

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