艾司氯氨酮椎管内麻醉对剖宫产产妇术后疼痛程度及阿片类药物用药量的影响  

Effects of intraspinal anesthesia with esketamine on pain degree and opioid dosage in puerperae after cesarean section

作　　者：赵慧磊 彭娟 王凯 ZHAO Huilei;PENG Juan;WANG Kai(Department of Anesthesiology,Nanchang Third Hospital,Nanchang,Jiangxi,330000,China)

机构地区：[1]南昌市第三医院麻醉科,江西南昌330000

出　　处：《当代医学》2023年第25期12-15,共4页Contemporary Medicine

基　　金：江西省卫生健康委科技计划项目(202311274)。

摘　　要：目的探讨艾司氯氨酮椎管内麻醉对剖宫产产妇术后疼痛程度、阿片类药物用药量的影响。方法选取2020年7月至2021年7月于南昌市第三医院麻醉科行剖宫产手术的80例产妇作为研究对象,简单随机分为观察组与对照组,每组40例。对照组采用硬膜外常规麻醉,观察组采用艾司氯氨酮椎管内麻醉。比较两组血流动力学指标、术后不同时间点疼痛程度、阿片类药物用药量及新生儿Apgar评分、不良反应发生情况。结果入室时,两组心率(HR)、收缩压(SBP)、舒张压(DBP)比较差异无统计学意义;麻醉后15 min,两组HR均快于入室时,SBP和DBP均低于入室时,但观察组HR慢于对照组,SBP、DBP均高于对照组,差异有统计学意义(P<0.05);两组组内、组间入室时与麻醉后15 min血氧饱和度(SPO_(2))比较差异无统计学意义。两组视觉模拟评分法(VAS)评分组间、时间、交互比较差异有统计学意义(P<0.05)。组内比较:术后4、12 h,两组VAS评分均低于术后2 h,且术后12 h低于术后4 h,差异有统计学意义(P<0.05)。组间比较:术后2、4、12 h,观察组VAS评分均低于对照组,差异有统计学意义(P<0.05)。两组阿片类药物用量组间、时间、交互比较差异有统计学意义(P<0.05)。组内比较:术后4、12 h,两组阿片类药物用量均多于术后2 h,且术后12 h多于术后4 h,差异有统计学意义(P<0.05)。组间比较:术后2、4、12 h,观察组阿片类药物用量均少于对照组,差异有统计学意义(P<0.05)。两组1、5 min新生儿Apgar评分情况比较差异无统计学意义。两组不良反应发生率比较差异无统计学意义。结论艾司氯氨酮椎管内麻醉可维持剖宫产产妇血流动力学稳定,减轻其术后疼痛程度,减少阿片类药物的使用,且不良反应较少,对新生儿的影响也较小,值得临床推广应用。Objective To investigate the effects of intraspinal anesthesia on pain and opioid dosage after cesarean section.Methods A total of 80 women who underwent cesarean section in Anesthesiology department of Nanchang Third Hospital from July 2020 to July 2021 were selected as the research subjects,and they were randomly divided into the observation group and the control group,with 40 cases in each group.The control group was given conventional epidural anesthesia,and the observation group was given intraspinal anesthesia with esketamine.The hemodynamic index,pain degree,opioid dosage at different time points,neonatal Apgar score and adverse reactions were compared between the two groups.Results In the case of entry,there were no significant differences in the heart rate(HR),systolic blood pressure(SBP),diastolic pressure(DBP)between the two groups;at 15 min after anesthesia,HR of the two groups were faster than those in the case of entry,SBP and DBP were lower than those in the case of entry,HR in the observation group was slower than that in the control group,and SBP and DBP were higher than those in the control group,the differences were statistically significant(P<0.05);there was no significant difference in oxygen saturation(SpO_(2))between the two groups at 15 min after anesthesia.There were significant differences in visual analogue scale(VAS)between the two groups of group,time points and interaction(P<0.05).Comparison within the group:at 4 and 12 h after operation,the VAS scores of the two groups were lower than those at 2 h after operation,and the at 12 h after operation was lower than at 4 h after operation,the differences were statistically significant(P<0.05).Comparison between groups:at 2,4 and 12 h after operation,the VAS scores in the observation group were lower than those in the control group,and the differences were statistical-ly significant(P<0.05).There were statistically significant differences in opioid dosage,between the two groups of group,time points and interaction(P<0.05).Comparison within

关 键 词：艾司氯氨酮 椎管内麻醉 剖宫产手术 疼痛程度 

分 类 号：R614[医药卫生—麻醉学] R71[医药卫生—外科学]