不同剂量艾司氯氨酮联合硬膜外麻醉用于剖宫产手术的临床研究  

Clinical study of different doses of esketamine combined with epidural anesthesia for cesarean section

作　　者：黄煌 罗宇 林学正 HUANG Huang;LUO Yu;LIN Xuezheng(Department of Anesthesia Surgery,Taizhou Central Hospital(Taizhou University Affiliat-ed Hospital),Taizhou 318000,China)

机构地区：[1]台州市中心医院(台州学院附属医院)麻醉手术科,浙江台州318000

出　　处：《全科医学临床与教育》2023年第3期210-213,共4页Clinical Education of General Practice

摘　　要：目的研究剖宫产患者应用不同剂量艾司氯氨酮静脉联合硬膜外麻醉对早期认知功能的影响。方法选取行剖宫产术的108例产妇,按照随机数字表法分为联合一组和联合二组,各54例。联合一组采用硬膜外麻醉联合0.2~0.5 mg/kg艾司氯氨酮静脉麻醉;联合二组采用硬膜外麻醉联合0.6~1 mg/kg艾司氯氨酮静脉麻醉。比较两组麻醉情况,麻醉前(T1)、切皮前(T2)、胎儿娩出时(T3)和手术结束时(T4)麻醉深度指数(AI)和速度、耐痛阈(PTO)和压痛阈(PPT)差值;比较两组T2~T4期间躁动-镇静评分(RASS)和术前24 h和术后3 d认知功能评分。结果两组清醒时间、自主呼吸建立时间、拔管时间、1 min和5 min新生儿Apgar评分比较,差异均无统计学意义(t分别=0.24、0.36、2.80、0.13,P均>0.05);联合一组术后12 h疼痛视觉模拟评分(VAS)评分较联合二组低(t=6.56,P<0.05);T1时,两组AI值比较,差异无统计学意义(t=0.95,P>0.05);T2~T4时,联合一组AI值均高于联合二组(t分别=5.60、5.45、6.22,P均<0.05);联合一组镇静深度和速度与联合二组比较,差异均无统计学意义(t分别=3.00、1.26,P均>0.05);联合一组和联合二组T1和T4时PTO和PPT差值比较,差异均无统计学意义(t分别=1.02、1.56,P均>0.05);T2~T4时,联合一组的RASS评分均高于联合二组(t分别=15.26、11.26、13.26,P均<0.05);两组术前24 h、术后3 d的简易精神状态检查量表(MMSE)评分比较无明显差异(t分别=0.88、0.97,P均>0.05)。结论剖宫产患者应用艾司氯氨酮0.2~0.5 mg/kg静脉联合硬膜外麻醉安全性高,镇静、镇痛效果明显,对产妇和胎儿影响最小。Objective To study the effect of different doses of esketamine intravenous combined with epidural anesthe⁃sia on early cognitive function in patients undergoing cesarean section.Methods Totally 108 pregnant women who un⁃derwent cesarean section were selected.According to the random number table method,they were divided into combined groupⅠand combined groupⅡ,with 54 cases in each group.The combined groupⅠwas received intravenous anesthe⁃sia combined with 0.2~0.5 mg/kg esketamine,while the combined groupⅡwas received 0.6~1 mg/kg esketamine.The anesthesia,depth of anesthesia index(AI),speed of sedation,pain tolerance(PTO)and pressure pain threshold(PPT)were compared between two groups before anesthesia(T1),skin incision(T2),the moment that fetus delivered(T3),the end of surgery(T4).The richmond agitation-sedation scale(RASS)at T2-T4 and cognitive function score at 24h before surgery and 3d after surgery between two groups were compared.Results There was no significant difference between the two groups in awake time,establishment time of spontaneous respiration,extubation time,1min and 5min Apgar scores of newborns(t=0.24,0.36,2.80,0.13,P>0.05).The VAS score at 12 hours after surgery in the combined groupⅠwas lower than that in the combined groupⅡ(t=6.56,P<0.05).At T1,there was no significant difference in AI between the two groups(t=0.95,P>0.05).At T2~T4,the AI value in combination groupⅠwas higher than that in combination groupⅡ(t=5.60,5.45,6.22,P<0.05).There was no significant diffe⁃rence between two groups in the depth and speed of sedation(t=3.00,1.26,P>0.05).There was no significant difference in the difference of PTO and PPT between two groups at T1 and T4(t=1.02,1.56,P>0.05).At T2-T4,the RASS score of combined groupⅠwas higher than that of combined groupⅡ(t=15.26,11.26,13.26,P<0.05).There was no significant difference in MMSE score at 24 hours be⁃fore surgery and 3 days after surgery between two groups(t=0.88,0.97,P>0.05).Conclusion The combination of in⁃travenous and epidural

关 键 词：艾司氯氨酮 硬膜外麻醉 剖宫产 认知功能 麻醉深度指数 

分 类 号：R614[医药卫生—麻醉学]