艾司氯胺酮复合顺阿曲库铵麻醉诱导在急诊剖宫产中的效果观察

郑丽花; 杨淑芬; 兰允平; 徐晨湛; 伍小敏

doi:10.16766/j.cnki.issn.1674-4152.002410

艾司氯胺酮复合顺阿曲库铵麻醉诱导在急诊剖宫产中的效果观察

doi: 10.16766/j.cnki.issn.1674-4152.002410

1.
温州医科大学附属衢州医院衢州市人民医院麻醉科，浙江衢州 324000
2.
浙江省人民医院麻醉科，浙江杭州 310014

基金项目:

浙江省卫生健康科技计划面上项目 2021KY461

“星晨”科研基金项目 2020-29

详细信息

通讯作者:
兰允平，E-mail：cxs159632@163.com

中图分类号: R614 R719.8
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- 被引次数: 0
出版历程
- 收稿日期: 2021-12-14
- 网络出版日期: 2022-08-20

Effect of anesthesia induction with esmketamine combined with cisatracurium in emergency cesarean section

1.
Department of Anesthesiology, Quzhou People ' s Hospital, Quzhou Hospital Affiliated to Wenzhou Medical University, Quzhou, Zhejiang 324000, China

摘要

摘要: 目的观察艾司氯胺酮复合顺阿曲库铵麻醉诱导在急诊剖宫产中的效果，探讨一种安全、有效的麻醉方法，为临床提供参考。方法将2020年1—12月衢州市人民医院收治的120例急诊剖宫产产妇按随机数字表法分为对照组和观察组，各60例，对照组采用瑞芬太尼复合顺阿曲库铵麻醉诱导，观察组采用艾司氯胺酮复合顺阿曲库铵麻醉诱导。比较2组的生命体征、产后疼痛评分、新生儿情况、抑郁评分及不良反应。结果 2组产妇心率及平均动脉压比较差异有统计学意义(均P＜0.05)；2组切皮时、取出胎儿时的心率及平均动脉压均高于麻醉前(均P＜0.05)；观察组术毕时的心率低于对照组(P < 0.05)，切皮时、取出胎儿时、术毕时的平均动脉压均低于对照组(均P＜0.05)。2组疼痛评分比较差异有统计学意义(均P＜0.05)；2组产后6、12、24、48 h疼痛评分均高于产后2 h(均P＜0.05)；观察组产后2、6、12、24、48 h疼痛评分均低于对照组(均P＜0.05)。观察组新生儿脐带血pH、Apgar评分均高于对照组(均P＜0.05)。观察组产后6周爱丁堡产后抑郁量表评分低于对照组[(7.62±3.29)分vs.(10.07±4.63)分, P＜0.05]。观察组不良反应发生率(3.33%)低于对照组(13.33%，P＜0.05)。结论艾司氯胺酮复合顺阿曲库铵麻醉诱导在急诊剖宫产中的应用效果较好，可稳定产妇生命体征，减轻产后疼痛与抑郁症状，改善新生儿情况，不良反应少。
- 艾司氯胺酮 /
- 顺阿曲库铵 /
- 麻醉诱导 /
- 急诊 /
- 剖宫产
Abstract: Objective To observe the effect of anesthesia induction with esmketamine combined with cisatracurium in emergency cesarean section, and to explore a safe and effective anesthesia method to provide reference for clinical practice. Methods A total of 120 emergency cesarean section parturients treated in Quzhou People ' s Hospital from January 2020 to December 2020 were randomly divided into control group and observation group. 60 cases in the control group were induced by remifentanil combined with cisatracurium anesthesia, and 60 cases in the observation group were induced by esmketamine combined with cisatracurium anesthesia. The Vital signs of the mother, postpartum pain score, neonatal condition, depression score and adverse reactions were compared between the two groups. Results There were significant differences in heart rate and mean arterial pressure between the two groups (all P < 0.05). The heart rate and mean arterial pressure at skin cutting and fetal removal in the two groups were higher than those before anesthesia (all P < 0.05). The heart rate at the end of operation in the observation group was lower than that in the control group (P < 0.05), and the average arterial pressure at the time of skin cutting, fetal removal and the end of operation were lower than those in the control group (all P < 0.05). There was significant difference in pain scores between the two groups (all P < 0.05). The pain scores at 6, 12, 24 and 48 hours postpartum in the two groups were higher than those at 2 hours postpartum (all P < 0.05). The pain scores of the observation group at 2, 6, 12, 24 and 48 hours postpartum were lower than those of the control group (all P < 0.05). The umbilical cord blood pH and Apgar score of newborns in the observation group were higher than those in the control group (all P < 0.05). The score of Edinburgh Postpartum Depression Scale in the observation group at 6 weeks postpartum was lower than that in the control group [(7.62±3.29) points vs. (10.07±4.63) points, P < 0.05]. The incidence of adverse reactions in the observation group (3.33%) was lower than that in the control group (13.33%, P < 0.05). Conclusion The application effect of anesthesia induction of esmketamine combined with cisatracurium in emergency cesarean section is good. It can stabilize maternal vital signs, reduce postpartum pain and depression, improve the situation of newborns, and has less adverse reactions.
- Esketamine /
- Cisatracurium /
- Anesthesia induction /
- Emergency treatment /
- Cesarean section

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表 1 2组产妇生命体征比较(x±s)

Table 1. Comparison of vital signs between two groups of parturients (x±s)

组别	例数	心率(次/min)				平均动脉压(mm Hg)
组别	例数	麻醉前	切皮时	取出胎儿时	术毕时	麻醉前	切皮时	取出胎儿时	术毕时
对照组	60	89.34±14.65	101.67±15.23^a	103.76±12.47^a	95.26±10.36	76.63±10.33	85.56±8.99^a	88.34±7.58^a	82.94±11.54
观察组	60	89.28±14.73	96.34±15.83^a	99.34±14.26^a	90.65±11.93	76.71±10.24	81.92±9.02^a	83.94±8.29^a	78.43±10.52
t值		0.022	1.879	1.807	2.260	0.043	2.214	3.034	2.237
P值		0.982	0.063	0.073	0.026	0.966	0.029	0.003	0.027
注：1 mm Hg=0.133 kPa；与麻醉前比较，^aP < 0.05。

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表 2 2组产妇产后VAS评分比较(x±s，分)

Table 2. Comparison of postpartum VAS scores between the two groups (x±s, 分)

组别	例数	产后2 h	产后6 h	产后12 h	产后24 h	产后48 h	F值	P值
对照组	60	1.67±0.36	2.25±0.40^a	3.62±1.05^a	3.07±0.76^a	2.85±0.91^a	4.623	＜0.001
观察组	60	1.19±0.22	2.02±0.33^a	2.84±0.92^a	2.31±0.72^a	2.40±0.72^a	4.145	＜0.001
t值		8.813	3.436	4.328	5.623	3.004
P值		＜0.001	＜0.001	＜0.001	＜0.001	0.002
注：与产后2 h比较，^aP < 0.05。

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表 3 2组新生儿情况比较(x±s)

Table 3. Comparison of newborns in two groups (x±s)

组别	例数	脐带血pH	Apgar评分(分)
对照组	60	7.11±0.54	8.77±0.46
观察组	60	7.37±0.18	9.65±0.29
t值		3.538	12.535
P值		＜0.001	＜0.001

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表 4 2组产妇EPDS评分比较(x±s，分)

Table 4. Comparison of EPDS scores of two groups of parturients (x±s, 分)

组别	例数	产前	产后6周
对照组	60	2.05±0.71	10.07±4.63
观察组	60	2.09±0.68	7.62±3.29
t值		0.315	3.341
P值		0.753	0.001

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表 5 2组产妇不良反应发生情况比较[例(%)]

Table 5. Comparison of adverse reactions of two groups of parturients [cases (%)]

组别	例数	恶心呕吐	嗜睡	头晕	头痛	幻觉	总发生
对照组	60	3(5.00)	1(1.67)	2(3.33)	1(1.67)	1(1.67)	8(13.33)
观察组	60	1(1.67)	0	1(1.67)	0	0	2(3.33)
注：2组不良反应总发生率比较，χ²=3.927，P=0.048。

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