摘要
目的 评价硬膜外分娩镇痛联合艾司氯胺酮对经阴道分娩初产妇的镇痛效果及产后抑郁(PPD)产后抑郁的影响.方法 选择2022年1月一2022年6月湖南师范大学附属长沙市妇幼保健院经阴道分娩的300例初产妇作为研究对象,根据是否接受分娩镇痛分为自然分娩组(Z组,58例)和分娩镇痛组(242例),分娩镇痛组按随机数字表法分为常规组(C组,119例)和艾司氯胺酮组(K组,123例).记录3组产妇分娩镇痛前,分娩时,产后2、24、48 h的视觉模拟评分法(VAS)疼痛评分;记录3组产妇入产房时、产后2h、产后1d、产后7d、产后42d的爱丁堡产后抑郁量表(EPDS)评分及PPD发生情况;检测3组产妇入产房时及产后1d时的雌激素、孕激素、5羟色胺(5-HT)、皮质醇水平.结果 C组、K组分娩时VAS疼痛评分,产后1d、7d、42dEPDS评分及产后2h、1d、7dPPD发生率低于Z组(均P＜0.05);C组、K组产后1d雌激素、孕激素、5-HT、皮质醇水平高于Z组(均P＜0.05).K组产后1d、42d EPDS评分,产后1d PPD发生率低于C组(均P＜0.05);K组产后1d孕激素、皮质醇水平高于C组(均P＜0.05).其余指标差异无统计学意义(均P＞0.05).结论 硬膜外分娩镇痛复合艾司氯胺酮后未改善镇痛效果,但可进一步降低PPD的发生风险.
Abstract
Objective To evaluate the effect of epidural labor analgesia combined with esketamine on analgesic effect and postpartum depression(PPD)in primiparous women who delivered vaginally.Methods A total of 300 primiparous women who deliv-ered vaginally in Changsha Maternal and Child Health Hospital Affiliated to Hunan Normal University from January to June 2022 were selected.According to whether they received labor analgesia,they were divided into two groups:a natural delivery group(group Z,n=58)and a labor analgesia group(n=242).According to the random number table method,the labor analgesia group was sub-divided into two groups:a routine group(group C,n=119)and an esketamine group(group K,n=123).Their Visual Analogue Scale(VAS)scores were recorded before labor analgesia,during labor,and at postoperative 2 h,24 h,and 48 h.The Edinburgh Postnatal Depression Scale(EPDS)scores and the incidence of PPD were also recorded when the primiparous women entered the delivery room,at postoperative 2 h,and on postoperative 1,7,and 42 days.The levels of oestrogen,progesterone,5-hydroxytryptamine(5-HT),and cortisol were detect-ed when the primiparous women entered the delivery room,and at postoperative 1 day.Results Compared with group Z,group C and group K showed decreases in VAS score during labor,and decreases in EPDS scores on postoperative 1,7,and 42 days,with a re-duced PPD incidence at postoperative 2 h,1 day and 7 days(all P＜0.05).Group C and group K also presented increases in the levels of estrogen,progesterone,5-HT and cortisol on postoperative 1 day,compared with group Z(all P＜0.05).The EPDS scores on postopera-tive 1 day and 42 days and the PPD incidence on postoperative 1 day in group K were lower than those in group C(all P＜0.05).The lev-els of progesterone and cortisol on postoperative 1 day in group K were higher than those in group C(all P＜0.05).There was no statisti-cal difference in other indicators(all P＞0.05).Conclusions Epidural labor analgesia combined with ketamine does not improve an-algesic effect,but can further reduce the risk of postpartum depression.
基金项目
湖南省卫健委科研项目(D202304116404)
湖南省医学会医学科研基金重点课题(HMA202101010)
NETL
NSTL
万方数据