艾司氯胺酮防治剖宫产术实施硬膜外麻醉后寒战的作用研究

Effect of esketamine on prevention and treatment of shivering after epidural anesthesia during cesarean section

目的观察不同剂量艾司氯胺酮防治剖宫产术实施硬膜外麻醉后寒战的有效性和安全性。方法选择大连市妇女儿童医疗中心(集团)2021年2—4月行剖宫产且美国麻醉医师协会分级为Ⅰ~Ⅱ级的90例产妇,按照随机数字表法分为三组,0.9%氯化钠组(C组,30例);艾司氯胺酮0.25 mg/kg组(K1组,30例);艾司氯胺酮0.50 mg/kg组(K2组,30例)。每组产妇在硬膜外麻醉后静脉给药,观察和记录产妇的一般情况、寒战、镇静、新生儿Apgar评分、精神症状及恶心呕吐等不良反应。结果最终完成研究81例,C组27例,K1组28例,K2组26例。寒战评估:K1组和K2组均未发生2/3级寒战,而在C组2/3级寒战发生率分别为25.93%(7/27)和70.37% (19/27),差异有统计学意义(P<0.05);镇静评估:K1组和K2组轻/中度镇静发生率分别为92.86%(26/28)和7.14%(2/28)、3.85%(1/26)和96.15%(25/26),明显高于C组,差异有统计学意义(P<0.01);三组产妇精神症状和恶心呕吐的发生率及新生儿Apgar评分比较差异均无统计学意义(P>0.05)。结论 0.25和0.50 mg/kg的艾司氯胺酮均能有效防治剖宫产术实施硬膜外麻醉后寒战的发生且无明显的不良反应。

Objective To observe the efficacy and safety of different doses of esketamine in the prevention and treatment of shivering after epidural anesthesia during cesarean section.Methods Ninety women with American Society of Anesthesiologists gradeⅠtoⅡwho underwent cesarean section from February to April 2021 in Dalian Women and Children′s Medical Center(Group)were divided into three groups by random digits table method:0.9%sodium chloride group(group C,30 cases);0.25 mg/kg esketamine group(K1 group,30 cases);esketamine 0.50 mg/kg group(K2 group,30 cases).After epidural anesthesia,each group was given the drugs in the trial plan intravenously.General condition,shivering,sedation,Apgar score,psychiatric symptoms,nausea and vomiting were observed and recorded.Results Finally,81 cases were completed,including 27 cases in group C,28 cases in group K1,and 26 cases in group K2.Shivering assessment:there was no grade 2/3 shivering in K1 group and K2 group,but the incidence of grade 2/3 shivering in C group was 25.93%(7/27)and 70.37%(19/27)the difference was statistically significant(P<0.05).Sedation assessment:in the groups of K1 and K2,incidences of mild/moderate sedation were 92.86%(26/28)/7.14%(2/28)and 3.85%(1/26)/96.15%(25/26),respectively,obviously higher than those of group C,the differences were statistically significant(P<0.01);there were no significant differences in the incidences of maternal mental symptoms,nausea and vomiting,and Apgar score of newborns among the three groups(P>0.05).Conclusions 0.25 and 0.50 mg/kg esketamine are effective in preventing and treating shivering after cesarean section with epidural anesthesia without obvious adverse reactions.