高龄产妇剖宫产术中艾司氯胺酮镇痛效果及妊娠结局分析

Analgesic effect of esketamine used in cesarean section of advanced pregnant women and the analysis of the pregnancy outcomes of the women

目的:探讨艾司氯胺酮在高龄产妇剖宫产术中的镇痛效果并分析妊娠结局。方法:选取2019年7月—2022年6月在本院行剖宫产术的高龄产妇166例,采用随机数目表法分为两组各83例,均给予硬膜外阻滞,切皮前1min对照组给予生理盐水,观察组给予艾司氯胺酮。比较两组麻醉效果和运动阻滞效果、麻醉镇痛效果、疼痛和认知功能、不良反应以及不同镇痛效果产妇的妊娠结局。结果:观察组麻醉起效时间、到达最高阻滞平面时间、Bromage评级、运动恢复时间均低于对照组,麻醉维持时间高于对照组(P<0.05)。两组术后2h、4h、12h的MMSE评分均较术前降低但两组无差异(P>0.05),VAS评分观察组低于对照组(P<0.05)。观察组麻醉镇痛效果优于对照组,麻醉良好率(97.6%)高于对照组(84.3%)(P<0.05),不良反应发生率(18.1%)与对照组(10.8%)无差异(P>0.05)。麻醉良好组妊娠不良结局发生率(7.3%)低于麻醉不良组(26.7%)(P<0.05)。结论:高龄产妇剖宫产术中应用艾司氯胺酮可提高麻醉效果,促进运动恢复,减轻术后疼痛,且不增加不良反应,麻醉效果不好时会增加妊娠不良结局。

Objective:To investigate the analgesic effect of esketamine used in cesarean section of advanced pregnant women,and to analyze the pregnancy outcomes of the women.Methods:166advanced pregnant women who wanted cesarean section were selected and randomly divided into two groups(83cases in each group)from July 2019to June 2022.These women in the two groups were given epidural block during cesarean section.The women in the study group were given esketamine additionally,and the women in the control group were given normal saline.The effectiveness of anesthesia,motor block,and the analgesia,the situations of pain and cognitive function,the adverse reactions rate,and the pregnancy outcomes in different analgesic effects of the women were compared between the two groups.Results:The onset time of anesthesia,the time to reach the highest blocking plane,the Bromage rating score,and the exercise recovery time of the women in the study group were significantly lower than those of the women in the control group,while the time of anesthesia maintenance of the women in the study group was significantly higher(P<0.05).The MMSE scores of the women in the two groups at 2h,4h,and 12hafter surgery were significantly lower than those before surgery,but which had no significant difference of the women between the two groups(P>0.05).The VAS scores of the women in the study group were significantly lower than those of the women in the control group at 2h,4h,and 12hafter surgery,and which of the women in the study group were significantly lower than those of the women in the control group(P<0.05).The analgesic effect of the women in the study group was significantly better than that of the women in the control group,and the rate of good anesthesia(97.6%)of the women in the study group was significantly higher than that(84.3%)of the women in the control group(P<0.05),there was no significant difference in the incidence of adverse reactions(18.1%vs.10.8%)of the women between the two groups(P>0.05).The incidence of adverse pregnancy outcomes(7.3%)of the women with good anesthesia was significantly lower than that(26.7%)of the women with poor anesthesia(P<0.05).Conclusion:Esketamine used in cesarean section of advanced pregnant women can improve their anesthetic effect,promote their recovery of exercise,and can alleviate their postoperative pain,and which will not increase their adverse reactions.Poor anesthetic effect will increase the adverse pregnancy outcomes of the women.