艾司氯胺酮复合罗哌卡因行硬膜外自控镇痛对剖宫产患者的影响

Effect of esketamine combined with ropivacaine in patients with cesarean section undergoing patient-controlled epidural analgesia

目的 探讨艾司氯胺酮复合罗哌卡因对行自控硬膜外镇痛(PCEA)剖宫产患者的影响。方法 选取在腰-硬联合麻醉下行剖宫产的足月妊娠产妇76例,随机分为K组(艾司氯胺酮)和C组(对照),每组38例。K组镇痛泵配方:艾司氯胺酮50 mg+罗哌卡因200 mg;C组镇痛泵配方:罗哌卡因200 mg。观察2组患者术后6、12、24、36、48 h静息和活动(屈髋)时的疼痛数字评分法(NRS)评分。比较2组40项恢复质量评分量表(QoR-40)评分。比较2组术后不良反应发生情况。结果 K组术后24、36、48 h静息时NRS评分低于C组,差异有统计学意义(P<0.05);K组术后12、24、36、48 h活动时NRS评分低于C组,差异有统计学意义(P<0.05)。K组术后1、2 d QoR-40评分高于C组,差异有统计学意义(P<0.05)。K组术后寒战、恶心呕吐发生率低于C组,差异有统计学意义(P<0.05)。结论 产妇剖宫产术后采用艾司氯胺酮复合罗哌卡因行PCEA,可优化镇痛效果,减少不良反应,提高恢复质量。

Objective To investigate the effect of esketamine combined with ropivacaine in patients with cesarean section undergoing patient-controlled epidural analgesia(PCEA).Methods A total of 76 full-term pregnant women who delivered cesarean section under combined lumbo-epidural anesthesia were selected,and randomly divided into group K(esketamine) and group C(control),with 38 cases in each group.Group K was given analgesic pump formula(esketamine 50 mg+ ropivacaine 200 mg),group C was given analgesic pump formula(ropivacaine 200 mg).Numerical pain scores(NRS) at rest and activity(hip flexion) were observed in two groups at 6,12,24,36 and 48 h after surgery.The 40-item Recovery Quality Scale(QoR-40) scores was compared between the two groups.The occurrence of postoperative adverse reactions was compared between the two groups.Results The NRS scores of the group K were significantly lower than that of the group C at rest 24,36 and 48 hours after operation(P<0.05);the NRS scores of the group K were significantly lower than that of the group C at 12,24,36 and 48 h after operation(P<0.05).The QoR-40 scores of the group K were significantly higher than that of the group C at 1 day and 2 days after operation(P<0.05).The incidence of postoperative chills,nausea and vomiting in the group K was significantly lower than that in the group C(P<0.05).Conclusion Esketamine combined with ropivacaine for PCEA after cesarean section can optimize analgesic effect,reduce adverse reactions and improve recovery quality.