艾司氯胺酮与丙泊酚分别复合瑞芬太尼在剖宫产术中的应用效果比较

Comparison of the application effects of esketamine and propofol combined with remifentanil in cesarean section

目的探讨艾司氯胺酮与丙泊酚分别复合瑞芬太尼对剖宫产手术产妇的镇痛镇静效果。方法选取2021年7月至2022年12月于张家口市第一医院收治的100例剖宫产手术产妇,根据麻醉方案不同分为观察组与对照组,每组50例。观察组给予艾司氯胺酮复合瑞芬太尼全身麻醉,对照组给予丙泊酚复合瑞芬太尼全身麻醉,比较两组术中不同时间点血流动力学变化[心率(HR)、平均动脉压(MAP)]、镇痛镇静效果、瑞芬太尼每小时使用剂量、产妇麻醉后恢复室停留时间及术后不良反应发生率。并观察两组新生儿脐动脉血血气参数[二氧化碳分压(PaCO_(2))、动脉氧分压(PaO_(2))和脐血pH]及娩出后1 min和5 min Apgar评分。结果观察组麻醉总有效率(94.00%)高于对照组(80.00%)(P<0.05);两组麻醉后10 min、切皮时、胎儿娩出时、术毕时HR、MAP较麻醉前降低,且观察组低于对照组(P<0.05);两组新生儿脐动脉血PaCO_(2)、PaO_(2)比较,差异无统计学意义(P>0.05);观察组新生儿脐动脉血pH、新生儿娩出后1 min、5 min Apgar评分较对照组高(P<0.05);观察组瑞芬太尼每小时的使用剂量及产妇麻醉后恢复室停留时间少于对照组(P<0.05);两组术后不良反应发生率比较,差异无统计学意义(P>0.05)。结论艾司氯胺酮复合瑞芬太尼全身麻醉可有效平衡产妇剖宫手术中血流动力学,提高镇静镇痛效果,减少瑞芬太尼使用剂量及产妇麻醉后恢复室停留时间,对新生儿的呼吸循环影响较小,术后安全性较高。

Objective To investigate the analgesic and sedative effects of esketamine and propofol combined with remifentanil on parturient undergoing cesarean section.Methods 100 cases of cesarean section admitted to Zhangjiakou First Hospital from July 2021 to December 2022 were selected and divided into observation and control group according to the different anesthesia protocols,with 50 cases in each group.The observation group was given esmketamine combined with remifentanil,while the control group was given propofol combined with remifentanil.The hemodynamic changes at different time points during operation[heart rate(HR),mean arterial pressure(MAP)],analgesic and sedative effects,the dosage of remifentanil per hour,the length of stay in the recovery room after maternal anesthesia and the incidence of postoperative adverse reactions were compared between the two groups.The neonatal umbilical artery blood gas parameters[carbon dioxide partial pressure(PaCO_(2)),arterial oxygen partial pressure(PaO_(2))and umbilical cord blood pH],Apgar scores of newborns delivery at 1 min and 5 min were observed between the two groups.Results The total effective rate of anesthesia in the observation group(94.00%)was higher than that in the control group(80.00%)(P<0.05).HR and MAP in the two groups 10 min after anesthesia,at the time of skin incision,at the time of fetal delivery and at the end of operation were lower than those before anesthesia,while those in the observation group were lower than those in the control group(P<0.05).There was no statistically significant difference in PaCO_(2) and PaO_(2) between the two groups(P>0.05).Neonatal umbilical artery blood pH,and Apgar score 1 min and 5 min after delivery of newborns in the observation group were higher than those in the control group(P<0.05).The dosage of remifentanil per hour and the stay time in recovery room after anesthesia in the observation group were reduced compared with those in the control group(P<0.05).There was no statistically significant difference in the incidence of postoperative adverse reactions between the two groups(P>0.05).Conclusion Esketamine combined with remifentanil general anesthesia can effectively balance the hemodynamics during cesarean section,improve the sedative and analgesic effects,reduce the dosage of remifentanil and the length of stay in the recovery room after maternal anesthesia,with little influence on the respiratory circulation of the newborn and high postoperative safety.