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投稿时间：2024-06-14 网络发布日期：2024-12-21
投稿时间：2024-06-14 网络发布日期：2024-12-21
中文摘要: 目的 对硬膜外单次应用艾司氯胺酮在剖宫产在围术期镇痛镇静效果进行评估，并分析其在剖宫产硬膜外镇痛镇静的临床应用价值。方法 选择2021年10月至2022年3月南通大学附属如皋医院腰硬联合麻醉下行子宫下段剖宫产术产妇100例为研究对象，随机分为吗啡组和艾司氯胺酮组，各50例。在新生儿（Apgar评分≥8分）娩出，断脐胎盘取出5 min后，艾司氯胺酮组经硬膜外导管给予艾司氯胺酮20 mg+地塞米松5 mg+罗哌卡因9 mg用0.9%氯化钠稀释至6 mL；吗啡组经硬膜外导管给予吗啡2 mg+地塞米松5 mg+罗哌卡因9 mg用0.9%氯化钠稀释至6 mL。记录两组硬膜外给药后不同时间点产妇的VAS评分、Ramsay评分、术后补充镇痛药使用情况及不良反应。结果 两组在硬膜外给药后5 min、术毕时、术后24 h和术后48 h的VAS评分，术后首次使用补充镇痛药物的时间以及人数占比差异无统计学意义（P＞0.05）。硬膜外给药后5min艾司氯胺酮组Ramsay评分高于吗啡组（P＜0.05），术毕两组Ramsay评分差异无统计学意义（P＞0.05）。大小便困难（22.00% vs 4.00%, χ2=7.162, P＜0.05）及皮肤瘙痒（18.00% vs 0， χ2=7.814, P＜0.05）发生率吗啡组高于艾司氯胺酮组。结论 艾司氯胺酮与吗啡单次硬膜外应用在剖宫产围术期均有良好的镇痛效果，且艾司氯胺酮单次硬膜外应用对剖宫产术中镇静效果及减少术后不良反应发生方面优于吗啡。
Abstract:Objective To evaluate the analgesic and sedative effect of single epidural application of esketamine in cesarean section during perioperative period, and analyze the clinical application value of esketamine in cesarean section epidural analgesia and sedation. Methods From October 2021 to March 2022, 100 patients undergoing lower segment cesarean section under combined spinal epidural anesthesia in Rugao Hospital Affiliated to Nantong University were selected and randomly divided into morphine group (n=50) and esketamine group (n=50). After delivery of newborns (Apgar score ≥ 8) and removal of the umbilical placenta for 5 min, individuals in esketamine group were administered 20 mg ketamine, 5 mg dexamethasone plus 9 mg ropivacaine via an epidural catheter diluted with 0.9% sodium chloride to 6 mL; while individuals in morphine group were administered 2 mg morphine, 5 mg dexamethasone plus 9 mg ropivacaine via an epidural catheter, diluted with same volume (6 mL) of sodium chloride. The VAS score and Ramsay score at different time points after epidural administration, postoperative supplemental analgesic use and adverse reactions of the two groups were recorded. Results There was no significant difference between the two groups in VAS scores at 5 min after epidural administration, at the end of operation, 24 h after operation, and 48 h after operation, as well as the time of first use of supplementary analgesic drugs after operation and the proportion of the number of people (P＞0.05). At 5 min after epidural administration, Ramsay scores in esketamine group were significantly higher than those in morphine group (P＜0.05), and that there was no statistically difference in Ramsay scores between the two groups after surgery (P＞0.05). The incidence of dysuria (22.00% vs 4.00%, χ2=7.162, P＜0.05) and pruritus (18.00% vs 0, χ2=7.814, P＜0.05) in morphine group were higher than those in esketamine group. Conclusion Esketamine and morphine both exert effective analgesic effects during the perioperative period of cesarean section, and more importantly, ketamine is superior to morphine in sedative effect during cesarean section and reducing postoperative adverse reactions.
文章编号： 中图分类号：R614 文献标志码：A
基金项目:国家自然科学基金面上项目（81974171，82271254）；江苏省双创团队领军人才项目（JSSCTD202144）；江苏省特聘医学专家（苏卫人〔2020〕64号）；南通市卫生健康委员会科研课题 （MSZ2023075）
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引用文本：
孙玉峰,田演娇,杨小林,等.单次硬膜外注射小剂量艾司氯胺酮对剖宫产围术期镇静镇痛的影响[J].中国临床研究,2024,37(12):1845-1848,1859.
孙玉峰,田演娇,杨小林,等.单次硬膜外注射小剂量艾司氯胺酮对剖宫产围术期镇静镇痛的影响[J].中国临床研究,2024,37(12):1845-1848,1859.