目的 分析产后出血预测评分与产妇凝血指标的相关性,以及出血预测评分对阴道分娩产后出血的预测效能。方法 采用回顾性研究,纳入2021年1月—2022年12月河南科技大学第二附属医院收治的136例阴道分娩产妇,根据产后出血情况,将合并产后出血的36例患者列为病例组,其余100例列为对照组,比较两组患者的产后出血预测评分及凝血指标,经Spearman相关性系数验证产后出血预测评分结果与凝血指标的相关性,依据实际出血情况,验证产后出血预测评分、各凝血指标对产后出血的预测效能。结果 病例组患者的产后出血预测评分为（7.33±2.46）分,D-二聚体（D-D）为（2.62±0.41）mg/L,均高于对照组[（6.14±2.06）分、（2.17±0.45）mg/L],纤维蛋白原（FIB）为（4.42±1.25）g/L,低于对照组（5.23±1.16）g/L;活化部分凝血活酶时间（APTT）为（37.44±10.25）s,凝血酶原时间（PT）为（15.45±4.12）s,凝血酶时间（TT）为（16.77±4.25）s,均高于对照组[（30.11±10.12）s、（12.49±4.11）s、（13.34±4.18）s],差异具有统计学意义（P<0.05）。经Spearman相关性系数分析,产后出血预测评分与经阴道分娩产妇的D-D、APTT、PT、TT呈正相关,与FIB呈负相关。通过绘制受试者工作特征曲线（ROC）后得知,产后出血预测评分及凝血指标对产后出血均有一定预测价值,但产后出血预测评分的AUC值大于各凝血指标。结论 产后出血预测评分与产妇凝血功能指标呈正相关,将产后出血预测评分与凝血指标检测相结合能实现对产后出血的早期识别及诊断。

Objective To analyze the correlation between postpartum bleeding prediction score and maternal blood coagulation index and the prediction efficiency of postpartum bleeding in vaginal delivery．Methods This is a retrospective study．The cases were included from January 2021 to December 2022．The subjects of the study were 136 vaginal delivery mothers． According to the delivery situation,36 patients with postpartum bleeding were included in the case group,and the rest 100 patients were included in the control group．The postpartum bleeding prediction score and coagulation indicators of the two groups were compared．The correlation between postpartum bleeding prediction score and coagulation indicators was verified by Spearman correlation coefficient．According to the actual bleeding situation,verify the predictive score for postpartum bleeding and the diagnostic efficacy of various coagulation indicators on postpartum bleeding．Results According to the test,the predictive score for postpartum bleeding in the case group was（7.33±2.46）,D-dimer（D-D）was（2.62±0.41）mg/L,which were higher than those in the control group [（6.14±2.06）,（2.17±0.45）mg/L]．Fibrinogen（FIB）was（4.42±1.25）g/L,lower than the control group（5.23±1.16）g/L,activated partial thromboplastin time（APTT）was（37.44±10.25）s,prothrombin time（PT）was（15.45±4.12）s,and thrombin time（TT）was（16.77±4.25）s．Compared with the control group [（30.11±10.12）s,（12.49±4.11）s,and（13.34±4.18）s）],the above indicators were all higher（P<0.05）．Through Spearman correlation coefficient analysis,the predictive score of postpartum bleeding was positively correlated with the D-D,APTT,PT,TT,negatively correlated with the FIB of the parturient who delivered through vagina．After drawing the ROC curve,it was found that both the postpartum hemorrhage prediction score and coagulation indicators had certain predictive value for postpartum hemorrhage,but the AUC value of the postpartum hemorrhage prediction score was greater than each coagulation indicator．Conclusions The prediction score of postpartum bleeding is positively correlated with the coagulation function indicators of the parturient,combining the score and indicators can achieve early identification and diagnosis of postpartum bleeding．

目的 探讨头位分娩评分法在孕妇分娩过程中的应用价值。方法 选取2020年1月—2022年12月于郑州市妇幼保健院进行建档住院的4 000例待产分娩孕妇作为研究对象,所有孕妇在宫口已开时都给予头位分娩评分,观察与记录所有孕妇的分娩方式与头位分娩评分法状况,记录新生儿出生1 min与出生5 min的Apgar评分,记录所有孕妇的产后并发症发生情况。结果 在4 000例孕妇中,Apgar评分≤8分者156例、9~10分者894例、≥11分者2 950例。不同头位分娩评分法孕妇的年龄、孕周、孕次、产次对比差异无统计学意义（P>0.05）。≤8分者的剖宫产率为100.0%,9~10分者、≥11分者分别为35.3%、5.7%,对比差异有统计学意义（P<0.05）。≤8分者、9~10分者、≥11分者的新生儿出生1 min与出生5 min的Apgar评分对比差异无统计学意义（P>0.05）。≤8分者、9~10分者、≥11分者的产后发热、产后出血、产后血肿、产后尿潴留等并发症发生率为分别为13.5%、2.0%、0.2%,对比差异有统计学意义（P<0.05）。结论 头位分娩评分法在产科中处理头位分娩时具有指导价值,值得推广应用。

Objective To explore and analyze the application values of the head position delivery scoring method in the delivery process of 4 000 pregnant women．Methods Selected 4 000 cases of pregnant women as the study object,all pregnant women gave head delivery score,observed and recorded the delivery mode and head delivery scoring method,recorded the Apgar score of 1 min and 5 min,and recorded the occurrence of postpartum complications of all pregnant women．Results Among the 4 000 pregnant women,156 scored ≤8,894 scored 9-10,and 2 950 scored ≥11．There was no significant difference in the age,gestational age,pregnancy time and delivery status of pregnant women in different head delivery scoring methods（P>0.05）．The cesarean section of patients with ≤8 score was 100.0%,those with 9-10 score and those with ≥11 score were 35.3% and 5.7%,respectively,and there were significant differences（P<0.05）．There was no significant difference in Apgar score between newborns with ≤8 scores,9-10 scores and ≥11 scores at 1 min and 5 min after birth（P>0.05）．The incidence rates of puerperal fever,postpartum hemorrhage,postpartum hematoma and postpartum urinary retention were 13.5%,2.0% and 0.2% in patients with ≤8 score,9~10 score and ≥11 score,respectively,and there were significant differences（P<0.05）．Conclusions The head delivery scoring method has guiding value in handling head delivery in obstetrics and is worth promoting and applying．

药物递送系统对于各类疾病意义非凡,但传统药物载体面临细胞毒性强、组织相容性低、半衰期短和靶向性弱等诸多挑战。血小板及其相关衍生物作为新型药物载体具有更为显著的优势。由于血小板自身的生理特点,以及在肿瘤、心血管疾病、血栓性疾病、感染等多种疾病中发挥的病理生理作用,血小板能够弥补传统药物载体的缺陷,具有极大的临床转化意义。该文总结了血小板相关药物递送系统目前的研究进展,以期为新型药物载体研究提供参考。

Drug delivery systems are important for various diseases,but conventional therapeutic drug have many shortcomings,such as high cytotoxicity,low histocompatibility,short half-life and weak targeting．Platelets and their derivatives have more significant advantages as novel drug carriers．Platelets play an important role in the pathophysiology of a wide range of diseases including oncology,cardiovascular diseases,thrombosis and infection．In this paper,we summarized the current research progress of platelet-related drug delivery systems to provide a reference for the research of novel drug delivery systems．

目的 分析恶性梗阻性黄疸患者实施经皮肝穿刺胆道引流术后出院准备度情况,探究此类患者出院准备度的影响因素。方法 选择2020年9月—2023年4月于天津市人民医院消化内科接受经皮肝穿刺胆道引流术的80例恶性梗阻性黄疸患者,选择院内系统对入组患者的性别、年龄等资料进行统计,并使用出院准备度量表评估患者出院准备度,应用出院指导质量量表评估患者出院指导质量,选择Pearson相关性分析的措施对影响患者出院准备度和出院指导质量的关联进行分析,并分析患者出院准备度影响因素。结果 合并慢性疾病以及居住方式方面,不同亚组患者间出院准备度得分比较差异具有统计学意义（P<0.05）;Pearson相关性分析显示出院准备度量表各维度得分与出院指导质量得分呈正相关（均P<0.05）;Logistic回归分析显示,居住方式得分为出院准备度量表得分的独立影响因素（P<0.05）。结论 经皮肝穿刺胆道引流术恶性梗阻性黄疸患者出院准备度得分较低,通过改变患者居住方式、提高患者出院指导质量,将有助于提高患者出院准备度。

Objective To analyze the discharge readiness of patients with malignant obstructive jaundice after percutaneous transhepatic biliary drainage,and explore the influencing factors of discharge readiness of such patients．Methods A total of 80 patients with malignant obstructive jaundice who underwent percutaneous transhepatic biliary drainage in Tianjin People's Hospital from September 2020 to April 2023 were selected as the research objects．The data such as sex and age of the patients were statistically analyzed in the hospital system,and the discharge readiness scale was used to evaluate the discharge readiness of the patients．The discharge guidance quality scale was used to evaluate the discharge guidance quality of patients．Pearson correlation analysis was selected to analyze the relationship between the discharge readiness and the discharge guidance quality,analyze factors influencing patient discharge readiness．Results There was a statistically significant difference（P<0.05）in the comparison of discharge readiness scores between different subgroups of patients with combined chronic diseases and living habits．Pearson correlation analysis showed that the scores of each dimension of the discharge readiness measurement table were positively correlated with the scores of discharge guidance quality（all P<0.05）．Logistic regression analysis showed that the residential style score was an independent influencing factor（P<0.05）for the discharge readiness scale score．Conclusions The discharge readiness score of patients with malignant obstructive jaundice undergoing percutaneous liver puncture biliary drainage was low．By changing the patient's living style and improving the quality of discharge guidance,will help to improve the patient's discharge readiness．

目的 探讨责任制助产护理模式配合体位管理对高龄产妇分娩方式及产程的影响。方法 选择2023年6月—12月医院接收的高龄产妇68例进行研究，按照护理方式分为两组各34例，对照组为常规助产护理，观察组为责任制助产护理模式配合体位管理，比较两组分娩方式、产程、疼痛程度及护理满意度。结果 观察组阴道分娩率为76.47%（26例），高于对照组52.94%（18例），剖宫产率为8.82%（3例），低于对照组29.41%（10例）（χ2分别为4.121、4.660，均P＜0.05）。观察组第一产程（6.25±0.50）h、第二产程（0.79±0.21）h、总产程（7.15±0.63）h、宫口开大3 cm、10 cm时的疼痛程度（4.12±1.08）分、（6.29±1.25）分明显低于对照组（7.01±0.62）h、（0.96±0.30）h、（8.11±1.07）h、（7.84±1.45）分、（9.09±0.74）分（t分别为5.563、2.706、4.508、11.997、11.239，均P＜0.05）。观察组的护理满意度为97.06%（33例），比对照组的76.47%（26例）高（χ2=4.610，P=0.031）。结论 高龄产妇展开责任制助产护理模式配合体位管理可促进自然分娩，并缩短产程，减轻产时疼痛程度，降低剖宫产率，提高护理满意度。

Objective To explore the effect of responsibility midwifery nursing model combined with position management on delivery mode and labor process of elderly parturient．Methods A total of 68 cases of elderly pregnant women admitted to the hospital from June to December 2023 were selected,and they were divided into two groups according to the nursing mode,34 cases in each group．The control group was given routine midwifery nursing,and the observation group was given responsible midwifery nursing mode combined with position management．The methods of delivery,labor process,pain degree and nursing satisfaction of the two groups were compared．Results The vaginal delivery rate was 76.47%（26 cases）in the observation group,which was higher than 52.94%（18 cases）in the control group,and the cesarean section rate was 8.82%（3 cases）in the observation group,which was lower than 29.41%（10 cases）in the control group（χ²=4.121 and 4.660,P=0.042 and 0.030）．The pain degree of the first stage of labor（6.25±0.50）h,the second stage of labor（0.79±0.21）h,the total stage of labor（7.15±0.63）h,the pain degree of the cervical dilation 3 cm,10 cm in the observation group were significantly lower than those in the control group[（7.01±0.62）h,（4.12±1.08）points,（6.29±1.25）points vs （0.96±0.30）h,（8.11±1.07）h,（7.84±1.45）score,（9.09±0.74）score（t=5.563,2.706,4.508,11.997,11.239,P<0.05）．The nursing satisfaction of the observation group was 97.06%（33 cases）,which was higher than 76.47%（26 cases）of the control group（χ²=4.610,P=0.031）．Conclusion sResponsibility midwifery nursing mode combined with position management can promote natural childbirth,shorten the labor process,reduce the pain during labor,reduce the rate of cesarean section,and improve nursing satisfaction in elderly women,which is worthy of promotion．

目的 探讨与分析核磁弥散成像（DWI）及表观弥散系数（ADC）值在肝内非肿瘤性病变诊断与鉴别诊断中的价值。方法 选择2020年8月—2023年5月厦门大学附属第一医院收治的120例肝脏占位性病变患者为研究对象,所有患者均给予常规MRI与DWI,记录图像质量、信号特征,计算ADC值,评价诊断效能。结果 120例患者中,病理诊断为肝内非肿瘤性病变70例（非肿瘤组：肝脓肿32例、肝囊肿28例、肝炎性假瘤10例）,肝内肿瘤性病变50例（肿瘤组：肝血管瘤38例,肝癌12例）。非肿瘤组与肿瘤组的图像质量优良率分别为94.29%（66/70）与88.00%（44/50）,组间比较差异无统计学意义（χ²=1.509,P>0.05）。非肿瘤组的磁共振信号特征多为高信号（62.86%）,肿瘤组多为低信号（60.00%）,两组比较差异有统计学意义（χ²=45.691,P<0.05）。在b值为400 s/mm²和800 s/mm²条件下,非肿瘤组的ADC值（0.84±0.17、0.77±0.14）均低于肿瘤组（1.29±0.24、1.19±0.34）,差异有统计学意义（t=12.029、9.302,P<0.05）。DWI判断为肝内非肿瘤性病变68例,DWI在肝内非肿瘤性病变的鉴别诊断灵敏度与特异度分别为95.71%（67/70）和98.00%（49/50）,ROC曲线显示DWI在肝内非肿瘤性病变的诊断曲线下面积为0.895。结论 DWI在肝内非肿瘤性病变中的图像显示质量高,可通过信号特征与ADC判断病灶状况,对鉴别肝内非肿瘤性病变具有较高的诊断效能。

Objective To investigate and analyze the value of diffusion weighted imaging（DWI）and apparent diffusion coefficient（ADC）in the diagnosis and differential diagnosis of non neoplastic liver lesions．Methods A total of 120 patients with liver focal lesions admitted to the First Affiliated Hospital of Xiamen University from August 2020 to may 2023 were selected．All patients were given conventional MRI and DWI,the image quality and signal characteristics were recorded,the ADC value was calculated,and the diagnostic efficiency was evaluated．Results Among the 120 patients,70 cases were pathologically diagnosed as non neoplastic lesions（non tumor group,32 cases of liver abscess,28 cases of liver cyst,10 cases of hepatitis pseudotumor）,and 50 cases were neoplastic lesions（tumor group,38 cases of hepatic hemangioma,12 cases of liver cancer）．The excellent and good image quality rates of non tumor group and tumor group were 94.29%（66/70）and 88.00%（44/50）,respectively,and there was no significant difference between the two groups（χ²=1.509,P>0.05）．The MRI signal characteristics of non tumor group were mostly high signal（62.86%）,while the tumor group were mostly low signal（60.00%）,and the difference between the two groups was statistically significant（χ²=45.691,P<0.05）．When the b value was 400 s/mm² and 800 s/mm²,the ADC value of non tumor group（0.84±0.17,0.77±0.14）was significantly lower than that of tumor group．The difference was statistically significant（t=12.029,9.302,P<0.05）．Sixty-eight patients were diagnosed as non neoplastic lesions by DWI．The sensitivity and specificity of DWI in the differential diagnosis of non neoplastic lesions were 95.71%（67/70）and 98.00%（49/50）,respectively．The ROC curve shows that the area under the diagnostic curve of DWI for non tumor lesions in the liver was 0.895．Conclusion sDWI has high image quality in the diagnosis of non neoplastic lesions in the liver．Doctors can judge the status of lesions by signal characteristics and ADC,which has high diagnostic efficiency in the identification of non neoplastic lesions in the liver．

目的 了解广州市某净水公司职工脂肪肝检出情况,并分析影响因素。方法 选取2023年广州市某净水公司参加职业健康检查的职工为研究对象,收集研究对象的一般情况、个人史、职业史、身体质量指数（BMI）、血压、血生化指标、肝脏彩超等资料。对该人群脂肪肝的患病情况进行描述性分析,对脂肪肝的影响因素进行单因素及多因素Logistic回归分析。结果 共收集研究对象1 217人,检出脂肪肝543例,检出率为44.62%。单因素分析结果表明,脂肪肝的发生与性别、年龄、体质量指数、高血压相关（P<0.05）。接触硫化氢、氨的职工脂肪肝检出率高于非接触者（P<0.05）,且职工工龄越长,脂肪肝检出率越高（P<0.05）。患脂肪肝职工的肝功能、脂代谢、血糖及尿酸水平高于非脂肪肝者（P<0.05）。多因素Logistic回归分析提示,年龄、体质量指数、肝功能异常、脂代谢异常、高血糖、高尿酸是脂肪肝的影响因素（P<0.05）。结论 广州市某净水公司职工的脂肪肝检出率较高,脂肪肝的发生主要与年龄、体质量指数、肝功能异常、脂代谢异常、高血糖、高尿酸等因素相关。

Objective To investigate the prevalence of fatty liver disease and influencing factors among employees of a water purification company in Guangzhou．Methods Employees of a water purification company in Guangzhou who participated in occupational health examinations in 2023 were selected as the study subjects．The subjects' general conditions,personal history,occupational history,BMI,blood pressure,blood biochemical indicators,and liver ultrasound images were collected．Descriptive analysis was used to analyze the prevalence of fatty liver disease in this population．The influencing factors of fatty liver were analyzed by single factor and multiple factor Logistic regression．Results A total of 1 217 subjects were included in this study,and 543 were diagnosed as fatty liver disease,with a detection rate of 44.62%．The results of single factor analysis showed that the occurrence of fatty liver was closely related to gender,age,BMI and hypertension（P<0.05）．The analysis of occupational hazard factors showed that,the detection rate of fatty liver disease was higher in people exposed to hydrogen sulfide and ammonia compared to non-exposed individuals（P<0.05）．The longer the working years,the higher the detection rate of fatty liver（P<0.05）．The levels of liver function,lipid metabolism,blood glucose and uric acid in workers with fatty liver were higher than those in workers without fatty liver（P<0.05）．Multivariate Logistic regression analysis showed that age,BMI,abnormal liver function,abnormal lipid metabolism,high blood glucose levels and hyperuricemia were independent influencing factors for fatty liver disease（P<0.05）．Conclusions The detection rate of fatty liver disease among employees of a water purification company in Guangzhou is high,and the occurrence of fatty liver disease is mainly related to factors such as age,BMI,abnormal liver function,abnormal lipid metabolism,high sugar levels and hyperuricemia．

目的 探究脐动脉血流动力学指标、血脂、促甲状腺激素(TSH)对妊娠期糖尿病患者分娩结局的影响研究。方法 选取我院2021年1月—2021年11月收治的妊娠期糖尿病患者138例,采用随机数字表法分为对照组和研究组,每组各69例。比较2组患者体内脐动脉血流动力学指标、血脂指标及TSH相关指标表达水平差异及妊娠结局,并通过多元线性回归分析探究脐动脉血流动力学指标、血脂指标、TSH等相关指标与妊娠期糖尿病患者不良妊娠结局的相关性。结果 研究组孕妇脐动脉峰值流速/舒张末期流速(S/D)、阻力指数(RI)、三酰甘油(TG)、低密度脂蛋白(LDL)、TSH水平高于对照组,游离三碘甲状腺原氨酸(FT3)、游离甲状腺素(FT4)水平低于对照组(P<0.05);研究组孕妇巨大儿、剖宫产、新生儿低血糖发生率及新生儿体质量均高于对照组(P<0.05);多元线性回归方程显示:S/D、RI、TG、LDL、TSH水平变化均与不良妊娠结局存在相关性(R²=0.224,调整R²=0.201;F=9.504,P<0. 05),且影响顺序由大到小依次为 TG、TSH、RI、S/D、LDL。结论 妊娠期糖尿病孕妇体内的S/D、RI、TG、LDL、TSH水平异常可能会影响妊娠结局,临床可通过监测上述指标的变化,及时采取干预措施。

Objective To investigate the effects of umbilical artery hemodynamic indexes, blood lipids and thyroid stimulating hormone (TSH) on delivery outcomes in patients with gestational diabetes mellitus. Methods A total of 138 patients with gestational diabetes mellitus who were admitted to our hospital from January 2021 to November 2021 were selected and divided into a control group and a study group by random digital table, with 69 cases in each group. The differences in umbilical artery hemodynamic indexes, blood lipid indexes and TSH-related indexes and pregnancy outcomes were compared between the two groups, and multiple linear regression analysis was used to explore the relationship between umbilical artery hemodynamic indexes, blood lipid indexes, TSH, other related indexes and adverse pregnancy outcomes in patients with gestational diabetes mellitus. Results The systolic and diastolic peak volume ratio (S/D), resistive index (RI) of umbilical artery, triglyceride (TG), low density lipoprotein (LDL) and TSH in the study group were higher than those in the control group, while the levels of free triiodothyronine (FT3) and free thyroxine (FT4) were lower than those in the control group (P<0.05). The incidences of macrosomia, cesarean section, neonatal hypoglycemia and neonatal weight in study group were significantly higher than those in the control group (P<0.05). The multiple linear regression equation showed that the adverse pregnancy outcomes were correlated with changes of TG, TSH, RI, S/D, LDL levels (R²=0.224, adjusted R²=0.201; F=9.504, P<0.05), in descending order. Conclusions Abnormal levels of S/D, RI, TG, LDL, TSH and FT4 in pregnant women with gestational diabetes mellitus may affect the pregnancy outcomes. Clinical intervention measures can be taken by monitoring the changes of the above indicators.

非酒精性脂肪性肝病(NAFLD)是世界范围内慢性肝病的一个主要原因,约15%的NAFLD患者会发展为非酒精性脂肪性肝炎、肝纤维化、肝硬化甚至肝癌。目前其发病及进展机制尚未明确,也无有效治疗手段。因此,构建临床前NAFLD动物模型至关重要,有助于为NAFLD提供临床治疗的新方案。本文将系统分析目前已构建的NAFLD动物模型在临床前研究中的局限性,并重点总结和综述基于基因编辑在NAFLD动物模型构建中的应用及研究进展,这对于探讨NAFLD发病机制及新药研发具有重要的临床意义。

Nonalcoholic fatty liver disease (NAFLD) is a leading cause of chronic liver disease worldwide, and about 15% of NAFLD patients will develop into nonalcoholic steatohepatitis, hepatic fibrosis, cirrhosis, and ultimately hepatocellular carcinoma. However, the biological mechanism of the pathogenesis and progression of NAFLD is not fully understood, and there are still no effective or targeted therapies for NAFLD. Therefore, it is an urgent need to construct pre-clinical animal models of NAFLD, which will help to better understand and explore the potential therapeutic strategy in the treatment of NAFLD. Here, we summarize the recent advances and limitations of the established animal models of NAFLD and focus on the potential application and research progress of genome editing for constructing the animal models of NAFLD. There animal models will be very useful to reveal the pathologic mechanism of human NAFLD, and to screen new therapeutic drugs.

目的 分析艾司氯胺酮对剖宫产术后镇痛及肾素-血管紧张素-醛固酮系统（RAAS）、产后抑郁情况发生的影响。方法 研究对象为2020年5月—2021年6月在我院行剖宫产的96例孕产妇,根据麻醉药物的不同分为研究组50例和对照组46例,2组孕产妇均给予腰硬联合麻醉行剖宫产术,研究组于手术切皮前5 min静脉注射艾司氯胺酮0.2 mg/kg,对照组静脉注射等量生理盐水。比较2组孕产妇术后疼痛评分（VAS评分）、肾素活性（PRA）、血管紧张素-II（AT-II）、醛固酮（ALD）、爱丁堡产后抑郁量表（EPDS）、不良反应的发生情况。结果 与对照组比较,术后各时间点研究组孕产妇VAS评分均明显较低,差异具有统计学意义（P<0.01）。2组T1、T2、T3各时间点RAAS各指标均明显低于T0时间点（P<0.05）;研究组在T1、T2时间点RAAS各指标均明显低于对照组,差异具有统计学意义（P<0.05）。研究组术后3 d、术后6周EPDS评分均明显低于对照组（P<0.01）。2组不良反应总发生率比较无差异（P>0.05）。结论 艾司氯胺酮用于剖宫产术后镇痛效果显著,对产妇RAAS影响较小,并可缓解产妇抑郁症状,且不良反应发生率较低。

Objective To analyze the effect of esketamine on analgesia and renin angiotensin aldosterone system（RAAS）and the occurrence of postpartum depression after cesarean delivery．Methods The subjects were 96 pregnant women who underwent cesarean section in our hospital from May 2020 to June 2021,they were divided into 50 cases in the study group and 46 cases in the control group．Both groups of pregnant women were given combined spinal epidural anesthesia for cesarean section．The patients in study group were injected with esmketamine 0.2 mg/kg intravenously 5 minutes before skin incision,and those in control group were injected with the same amount of saline intravenously．The postoperative pain scores（VAS score）,plasma renin activity（PRA）,angiotensin-II（AT-II）,aldosterone（ALD）,Edinburgh Postpartum Depression Scale（EPDS）,and the occurrence of adverse effects were compared between the two groups．Results Compared with the control group,maternal VAS scores were significantly lower in the study group at all postoperative time points,and the differences were statistically significant（P<0.01）．The indexes of RAAS were significantly lower in both groups at T1,T2 and T3 time points than at T0 time point（P<0.05）;the indexes of RAAS were significantly lower in the study group at T1 and T2 time points than in the control group,and the differences were statistically significant（P<0.05）．The postoperative EPDS scores in the study group were significantly lower than those in the control group at 3 d and 6 weeks（P<0.01）．There was no difference in the overall incidence of adverse reactions between the two groups（P>0.05）．Conclusions Esketamine is effective for postoperative analgesia after cesarean section,with less effect on maternal RAAS,and can relieve maternal depressive symptoms,and has a low incidence of adverse reactions．