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| 亚麻醉剂量艾司氯胺酮对剖宫产术后睡眠及恢复质量的影响 |
| Effects of sub-anesthetic doses of esketamine on postoperative sleep and recovery quality after cesarean section |
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| DOI：10.12089/jca.2026.01.008 |
| 中文关键词: 艾司氯胺酮 术后睡眠 产后抑郁 产后恢复质量 |
| 英文关键词: Esketamine Postoperative sleep Postpartum depression Postpartum recovery quality |
| 基金项目:河北省卫健委医学科学研究课题计划项目（20240666）；沧州市科技重点研发计划项目（222106027） |
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| 中文摘要: |
目的：评估亚麻醉剂量艾司氯胺酮对剖宫产术后产妇睡眠质量及产后恢复质量的影响。
方法：选择2024年1—6月择期行剖宫产的产妇，年龄18～35岁，BMI 20.0～30.0 kg/m2，ASA Ⅱ级。采用随机数字表法将产妇分为两组：对照组（C组）和艾司氯胺酮组（E组）。在胎儿娩出并断脐后，E组立即静脉注射艾司氯胺酮0.25 mg/kg，C组给予等体积生理盐水。采用匹兹堡睡眠质量评分（PSQI）和理查兹-坎贝尔睡眠量表（RCSQ）评估产妇睡眠情况并使用Fibit智能手环记录产妇的睡眠时间以及觉醒次数。主要指标为术后1 d RCSQ评分。次要指标包括术前1 d、术后2 d RCSQ评分，术前1 d、术后1、2 d PSQI评分、总睡眠时间、深睡眠时间、觉醒次数，前1 d、术后1、2、42 d EPDS评分，术后12、24 h NRS疼痛评分，术后3 d QoR-40评分、首次下床活动时间、住院时间以及不良反应发生情况。
结果：最终纳入产妇104例，其中C组53例，E组51例。与C组比较，E组术后1、2 d PSQI评分明显降低，RCSQ评分明显升高，总睡眠时间明显延长，深睡眠比例明显升高，觉醒次数明显减少，术后1 d EPDS评分、术后12、24 h的NRS疼痛评分明显降低，舒芬太尼用量及补救镇痛次数明显减少，QoR-40评分明显升高，首次下床时间明显缩短（P<0.05）。两组不良反应发生率差异无统计学意义。
结论： 剖宫产术中单次应用亚麻醉剂量艾司氯胺酮可延长睡眠时间，改善睡眠质量，促进产后恢复，且不增加不良反应。 |
| 英文摘要: |
Objective: To investigate the effects of sub-anesthetic doses of esketamine administered on postoperative sleep and postpartum recovery quality after cesarean section.
Methods: Participants scheduled for elective cesarean section between January and June 2024 were enrolled, aged 18-35 years, BMI 20.0-30.0 kg/m2 and ASA physical status Ⅱ. Using a random number table, the participants were divided into two groups: control group (group C) and esketamine group (group E). After fetal delivery and umbilical cord clamping, group E received an intravenous injection of esketamine at a dose of 0.25 mg/kg, while group C was given an equal volume of normal saline. Sleep quality was assessed using the Pittsburgh sleep quality index (PSQI) and Richards-Campbell sleep questionnaire (RCSQ), sleep duration and wakefulness frequency were recorded using Fitbit smart wristbands. The primary outcome was the RCSQ score on the first postoperative day. The secondary outcomes included the RCSQ scores on the day before surgery and on the second postoperative day, the PSQI scores on the day before surgery and on the first and second postoperative days, total sleep time, deep sleep time, and the number of awakenings, the EPDS scores on the day before surgery and on the first, second, and 42nd postoperative days, and the NRS pain scores at 12 and 24 hours postoperatively, QoR-40 scores at 3 days postoperatively, time to first ambulation, length of hospital stay, and adverse events were also documented.
Results: There were 104 participants included, with 51 patients in group E and 53 in group C. Compared with group C, group E showed significantly lower PSQI scores and higher RCSQ scores on postoperative days 1 and 2, with longer total sleep duration, increased deep sleep percentage, fewer awakenings, lower EPDS scores on postoperative day 1, lower NRS pain scores at 12 and 24 hours postoperatively, reduced usage of sufentanil and rescue analgesia, higher QoR-40 scores, and earlier time to first ambulation (P < 0.05). There was no statistically significant difference in the incidence of adverse reactions between the two groups.
Conclusion: A single administration of sub-anesthetic doses of esketamine during cesarean section can extend sleep duration, improve sleep quality, alleviate postoperative pain, reduce the need for analgesics, accelerate postpartum recovery, and does not increase adverse reactions. |
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