目的:观察小剂量氯胺酮复合右美托咪定对剖宫产者术后疼痛、抑郁评分的影响.方法:选取2020年10月-2022年10月本院接收的拟行腰硬联合麻醉(CSEA)下剖宫产产妇80例,以随机数表法分为单一组和联合组各40例,两组均于麻醉前泵注0.5 μg/kg右美托咪定,联合组在取出胎儿后静注0.25 mg/kg氯胺酮.比较两组术后视觉模拟评分法(VAS)评分,术前及术后应激反应指标[肾上腺素(E)、去甲肾上腺素(NE)、皮质醇(Cor)]水平,术后40项恢复质量评分量表(QoR-40)评分,术前术后爱丁堡产后抑郁量表(EPDS)评分;统计两组不良反应.结果:术后2 h、6 h、12 h、24 h VAS评分联合组均低于单一组,术后6 h、24 h的E、NE、Cor水平两组均较术前提高但联合组低于单一组,术后 24 h、48 h QoR-40 评分联合组(189.74±2.82 分、194.15±3.14 分)均高于单一组(176.13±3.27 分、183.06± 3.59分),术后24 h、5 d EPDS评分两组均高于术前但联合组(6.18±2.24分、5.47±2.06分)均低于单一组(7.64± 2.65分、6.50±2.31分)(均P＜0.05);两组不良反应发生无差异(P＞0.05).结论:小剂量氯胺酮复合右美托咪定可减轻剖宫产产妇术后疼痛,减轻应激反应及抑郁情绪,改善产后恢复质量,且安全可靠.
Effects of the small dose of ketamine combined with dexmedetomidine used during cesarean section on postoperative pain and postpartum recovery
Objective:To observe the effects of the small dose of ketamine combined with dexmedetomidine used during cesarean section of women on their postoperative pain and postpartum recovery.Methods:A total of 80 women who wanted cesarean section under combined spinal-epidural anesthesia(CSEA)were selected and were divided into two study group and control group(40 cases in each group)by random number table method from October 2020 to October 2022.The women in the two groups were all given 0.5 μg/kg dexmedetomidine pumped before anesthesia.The women in the study group were given 0.25 mg/kg ketamine intravenous injections after fetal disengagement additionally.The postoperative score by visual analog scale(VAS),the levels of stress response index,such as epinephrine(E),norepi-nephrine(NE),and cortisol(Cor),the postoperative score by 40-item quality of recovery rating scale(QoR-40),and the preoperative and postoperative scores by Edinburgh Postpartum Depression Scale(EPDS)of the women were com-pared between the two groups.The adverse reactions of the women in the two groups were statistics analyzed.Results:The VAS scores of the women in the study group at postoperative 2 h,6 h,12 h and 24 h were significantly lower than those of the women in the control group.The E,NE and Cor levels of the women in the two groups at postoperative 6 h and 24 h were significantly higher than those of the women before operation,but which of the women in the study group were significantly lower than those of the women in the control group.The QoR-40 scores of the women in the study group at postoperative 24 h and 48 h(189.74±2.82 points and 194.15±3.14 points)were significantly higher than those(176.13±3.27 points and 183.06±3.59 points)of the women in the control group.The EPDS score of the women in the two groups at postoperative 24 h and in postoperative 5 days were significantly higher than those of the women before operation,but which(6.18±2.24 points and 5.47±2.06 points)of the women in the study group were significantly lower than those(7.64±2.65 points and 6.50±2.31 points)of the women in the control group(all P＜0.05).There was no significant difference in the incidence of the adverse reactions of the women between the two groups(P＞0.05).Conclusion:The application of the small dose of ketamine combined with dexmedetomidine in cesar-ean section of the women can reduce their postoperative pain,reduce their stress response and depression,and improve their quality of postpartum recovery,and with the safety and reliability.
Cesarean sectionSmall dose of ketamineDexmedetomidinePainStress responseDepressionPost-partum recovery
万方数据
维普
