小剂量艾司氯胺酮对腰硬联合阻滞分娩镇痛中瘙痒的影响  

Effect of low-dose esketamine on pruritus during combined spinal-epidural block for labor analgesia

作　　者：蒋皓宇 全守波 李静怡 张雪丰 Jiang Haoyu;Quan Shoubo;Li Jingyi;Zhang Xuefeng(Department of Anesthesiology,Songshan Lake Central Hospital of Dongguan City,Dongguan 523326,Guangdong Province,China;Department of Pain,Songshan Lake Central Hospital of Dongguan City,Dongguan523326,GuangdongProvince,China)

机构地区：[1]东莞市松山湖中心医院麻醉科,东莞523326 [2]东莞市松山湖中心医院疼痛科,东莞523326

出　　处：《中国基层医药》2024年第7期1032-1036,共5页Chinese Journal of Primary Medicine and Pharmacy

基　　金：广东省临床用药研究基金(外科药学骨科镇痛专项基金)(2021ZT19)。

摘　　要：目的观察小剂量艾司氯胺酮对腰硬联合阻滞分娩镇痛中瘙痒的影响。方法采用前瞻性随机对照试验,选取东莞市松山湖中心医院2021年11月至2022年4月行腰硬联合阻滞分娩的足月单胎初产妇46例,采用随机数字表法分为试验组、对照组各23例。在腰硬联合阻滞分娩镇痛前5 min,试验组静脉注射艾司氯胺酮0.125 mg/kg,对照组静脉注射等容量0.9%氯化钠注射液。两组产妇均在蛛网膜下腔注入舒芬太尼3μg,并置入硬膜外导管行患者自控镇痛。记录镇痛前、镇痛后30 min及宫口开全时两组产妇的瘙痒分级、疼痛视觉模拟(VAS)评分、Ramsay镇静评分、改良Bromage评分、平均动脉压、心率,记录第一产程活跃期时长、第二产程时长、器械助产率、剖宫产率、新生儿出生后阿普加评分。结果在镇痛实施30 min时,试验组瘙痒分级(无、轻、中、重例数分别为17、4、0、0例)少于对照组(无、轻、中、重例数分别为7、7、4、1例),差异有统计学意义(Z=-3.04,P<0.01);在宫口开全时,试验组瘙痒分级(无、轻、中、重例数分别为19、2、0、0例)少于对照组(无、轻、中、重例数分别为10、5、4、0例),差异有统计学意义(Z=-2.75,P<0.01)。两组产妇Ramsay镇静评分、改良Bromage评分、平均动脉压、心率、活跃期和第二产程时长、器械助产率及新生儿阿普加评分差异均无统计学意义(均P>0.05)。结论小剂量艾司氯胺酮可有效减轻腰硬联合阻滞分娩镇痛中的瘙痒。Objective To investigate the effect of low-dose esketamine on pruritus during combined spinal-epidural block for labor analgesia.Methods A total of 46 primigravida with full-term singleton pregnancy who underwent combined spinal-epidural block between November 2021 and April 2022 at Songshan Lake Central Hospital of Dongguan City were included in this study.These primigravida were divided into an experimental group and a control group(n=23 per group)using the random number table method.Five minutes prior to the administration of combined spinal-epidural block for labor analgesia,the experimental group received an intravenous injection of 0.125 mg/kg of esketamine,while the control group received an equal volume of 0.9%normal saline.Subsequently,3μg of Sufentanil was intrathecally injected,and an epidural catheter was inserted for patient-controlled analgesia.Pruritus grade,Visual Analogue Scale score,Ramsay sedation score,modified Bromage score,mean blood pressure,and heart rate were recorded before analgesia,30 minutes after analgesia,and at the time of full dilation of the cervix.The duration of the active phase of the first stage of labor,the duration of the second stage of labor,the rate of instrumental delivery,the cesarean section rate,and neonatal Apgar score were recorded.Results After 30 minutes of analgesia,the number of cases presenting with various grades of pruritus in the experimental group(no/mild/moderate/severe cases:17/4/0/0,respectively)was significantly lower than that in the control group(no/mild/moderate/severe cases:7/7/4/1,respectively;Z=-3.04,P<0.01).By the time the cervices were fully dilated,the number of cases presenting with various grades of pruritus in the experimental group(no/mild/moderate/severe cases:19/2/0/0,respectively)remained significantly lower than that in the control group(no/mild/moderate/severe cases:10/5/4/0,respectively;Z=-2.75,P<0.01).There were no statistically significant differences between the two groups in terms of Visual Analogue Scale score,Ramsay sedation s

关 键 词：镇痛 产科 麻醉 硬膜外 麻醉 脊椎 分娩 产道 瘙痒症 剂量效应关系 药物 艾司氯胺酮 

分 类 号：R614[医药卫生—麻醉学]