艾司氯胺酮联合硬膜外阻滞麻醉对剖宫产产妇术后镇痛与血浆皮质醇的影响

Effects of esketamine combined with epidural anesthesia on postoperative analgesia and plasma cortisol in cesarean section women

目的探究艾司氯胺酮联合硬膜外阻滞麻醉对剖宫产产妇术后镇痛与血浆皮质醇的影响。方法前瞻性选取2019年1月至2021年12月在青岛市中医医院就诊的行剖宫产产妇84例,按照随机数字表法分为对照组与研究组,每组42例。两组均行硬膜外阻滞麻醉,对照组术中给予利多卡因进行麻醉,研究组术中给予艾司氯胺酮+利多卡因进行麻醉。比较两组感觉麻醉情况、围手术期指标、疼痛情况[(视觉模拟评分法(VAS)评分)]、血浆指标[皮质醇、纤维蛋白原(FIB)、D-二聚体(D-D)、凝血酶原时间(PT)]及不良反应。结果研究组感觉麻醉Ⅰ、Ⅱ、Ⅲ、Ⅳ级占比分别为78.57%、19.05%、2.38%、0,优于对照组(57.14%、30.95%、11.90%、0),差异有统计学意义(P<0.05)。研究组感觉阻滞用时为(4.13±1.05)min,短于对照组[(7.38±2.12)min],术后使用镇痛药物患者比率为23.81%,低于对照组(47.62%),差异均有统计学意义(P<0.05)。术后6、12、24、48 h,研究组VAS评分分别为(2.48±0.61)、(2.52±0.66)、(1.71±0.38)、(0.95±0.15)分,均低于对照组[(3.35±0.74)、(3.64±0.53)、(1.88±0.32)、(1.04±0.21)分],差异均有统计学意义(P<0.05)。术后24 h,研究组皮质醇、FIB、D-二聚体、PT分别为(615.39±20.12)ng/mL、(3.41±0.52)g/L、(0.45±0.11)mg/L、(11.80±1.12)s,均低于对照组[(742.38±26.53)ng/mL、(3.74±0.61)g/L、(0.63±0.19)mg/L、(12.74±1.39)s],差异均有统计学意义(P<0.05)。研究组不良反应总发生率为16.67%,低于对照组(38.10%)低,差异有统计学意义(P<0.05)。结论艾司氯胺酮联合硬膜外阻滞麻醉对剖宫产产妇术后镇痛效果较好,可有效抑制术中血浆皮质醇分泌,且安全性较高。

Objective To investigate the effect of esketamine combined with epidural anesthesia on postoperative analgesia and plasma cortisol in cesarean section women.Methods A prospective study was conducted on 84 postpartum women who underwent cesarean section at Qingdao Traditional Chinese Medicine Hospital from January 2019 to December 2021.They were divided into the control group and the study group using a random number table method,with 42 cases in each group.Both groups were given epidural anesthesia,the control group was given lidocaine for anesthesia,and the study group was given esketamine+lidocaine for anesthesia.The anesthesia,perioperative indicators,pain[visual analogue scale(VAS)score],plasma indicators[cortisol,fibrinogen(FIB),D-dimer,prothrombin time(PT)]and adverse events were compared between the two groups.Results The proportions of gradesⅠ,Ⅱ,Ⅲ,Ⅳof sensory anesthesia in the study group were 78.57%,19.05%,2.38%and 0,which were better than those in the control group(57.14%,30.95%,11.90%,0),the difference was statistically significant(P<0.05).The duration of sensory block in the study group was(4.13±1.05)min,which was shorter than that in the control group[(7.38±2.12)min],and postoperative pain medication was 23.81%,which was less than that in the control group(47.62%),the differences were statistically significant(P<0.05).At 6,12,24,and 48 hours after surgery,the VAS scores of the study group were(2.48±0.61),(2.52±0.66),(1.71±0.38),and(0.95±0.15)points,respectively,which were lower than those in the control group[(3.35±0.74),(3.64±0.53),(1.88±0.32),and(1.04±0.21)points],and the differences were statistically significant(P<0.05).At 24 hours after surgery,the levels of cortisol,FIB,D-dimer,and PT in the study group were(615.39±20.12)ng/mL,(3.41±0.52)g/L,(0.45±0.11)mg/L,and(11.80±1.12)s,respectively,which were lower than those in the control group[(742.38±26.53)ng/mL,(3.74±0.61)g/L,(0.63±0.19)mg/L,and(12.74±1.39)s],and the differences were statistically significant(P<0.05).The total incidence of adverse reactions in the study group was 16.67%,which was lower than that in the control group(38.10%),and the difference was statistically significant(P<0.05).Conclusion Esketamine combined with epidural anesthesia has better analgesic effect on postoperative cesarean section women,and can effectively inhibit intraoperative plasma cortisol secretion with high safety.