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| 右美托咪定复合舒芬太尼静脉镇痛对剖宫产术后镇痛效果及产后抑郁的影响 |
| Effects of dexmedetomidine combined with sulfentanyl in postoperative analgesia and postpartum depression undergoing cesarean section |
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| DOI：10.12089/jca.2018.06.009 |
| 中文关键词: 右美托咪定 剖宫产术后镇痛 产后抑郁 脑源性神经营养因子 |
| 英文关键词: Dexmedetomidine Postoperative analgesia after cesarean section Postpartum depression Brain derived neurotrophic factor |
| 基金项目:2016年无锡市卫生计生科技成果和适宜技术推广项目(T201602) |
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| 中文摘要: |
目的 观察右美托咪定复合舒芬太尼对剖宫产术后镇痛效果、产后抑郁发生情况以及脑源性神经营养因子(brain-derived neurotrophic factor, BDNF)的影响。
方法 择期行剖宫产产妇60例, 年龄25～35岁，ASA Ⅰ或Ⅱ级,采用随机数字表法分为右美托咪定复合舒芬太尼组(D组)和舒芬太尼组(S组)。D组静脉泵注右美托咪定1 μg·kg-1·h-1至术毕, 接镇痛泵(舒芬太尼0.02 μg/kg+右美托咪定0.08 μg/kg+阿扎司琼20 mg+生理盐水稀释至105 ml)；S组静脉泵注生理盐水1 μg·kg-1·h-1至术毕, 接镇痛泵(舒芬太尼0.02 μg/kg+阿扎司琼20 mg+生理盐水稀释至105 ml)。术后4 h(T1)、8 h(T2)、12 h(T3)、24 h(T4)、48 h(T5)分别采用视觉模拟评分(VAS)、Ramsay镇静评分法评价疼痛、镇静程度, 并记录术毕(T0)至术后各时间段镇痛泵有效按压次数。记录术后48 h不良反应发生率。根据爱丁堡产后抑郁量表(Edinburgh postnatal depression scale, EPDS)分别记录产妇术后1周和6周的EPDS评分。检测产后1周和6周的血清BDNF浓度。
结果 T2,T4和T5时D组VAS评分明显低于S组(P<0.05);T0—T4各时间段D组镇痛泵有效按压次数明显少于, 术后恶心呕吐发生率明显低于S组(P<0.05)。产后1周和6周D组EPDS评分明显低于,BDNF浓度明显高于S组(P<0.05)。
结论 右美托咪定明显增加舒芬太尼在剖宫产术后的镇痛作用, 减轻产后抑郁的程度, EPDS与剖宫产术后抑郁病情正相关, BDNF似可作为预测术后产后抑郁发生及临床疗效评定生物指标。 |
| 英文摘要: |
Objective To observe the effects of dexmedetomidine combined with sulfentanyl in postoperative analgesia and postpartum depression undergoing cesarean section, and the relationship between brain-derived neurotrophic factor (brain-derived neurotrophic factor, BDNF) and postpartum depression.
Methods Sixty puerperas of selective cesarean section, aged 25-35 years, ASA physical status Ⅰ or Ⅱ, were divided into group S and group D, 30 cases in each group. Both groups of puerperas were taken for postoperative intravertebral analgesia. After delivery of fetus, group S was intravenously administrated with normal saline 1 μg·kg-1·h-1 up to the end of operation, given sulfentanyl 0.02 μg·kg-1·h-1 and azasetron 20 mg for, 105 ml postoperative analgesia pump; group D was intravenous administrated with dexmedetomidine 1 μg·kg-1·h-1 until the end of the operation, both groups were given 105 ml postoperative analgesia containing sulfentanyl 0.02 μg·kg-1·h-1, dexmedetomidine 0.08 μg·kg-1·h-1 and azasetron 20 mg in analgesia pump. The visual analogue scale and Ramsay sedation score were applied to evaluate pain degrees and sedation scores 4 h after surgery (T1), 8 h after surgery (T2), 12 h after surgery (T3), 24 h after surgery (T4), and 48 h after surgery (T5). The incidences of adverse reactions were recorded. The scores of Edinburgh postnatal depression scale (EPDS) were also recorded, as well as the BDNF content.
Results Compared to group S, the VAS scores in group D at T2, T4 and T5 were lower (P < 0.05). The effective pressing numbers of patient-controlled analgesia of group S were significantly more than those of group D (P < 0.05). The incidences of nausea and vomiting in group D were lower than those in group C (P < 0.05). One week and 6 weeks after the operation, the scores of EPDS in group D were lower than those in group S (P < 0.05). The level of serum BDNF in group D was higer than that in group S 1 or 6 weeks after the cesarean (P < 0.05).
Conclusion Dexmedetomidine combined with sulfentanyl in postoperative analgesia can significanty strengthen the analgesia by sulfentanyl alone, and reduce the incidence of postpartum depression, which is related with BDNF. |
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