不同剂量艾司氯胺酮复合舒芬太尼在剖宫产术后静脉自控镇痛中的应用效果

Application effect of different doses of Esketamine combined with Sufen-tanil on patient-controlled intravenous analgesia after cesarean

目的探讨不同剂量艾司氯胺酮复合舒芬太尼在剖宫产术后静脉自控镇痛(PCIA)中的应用效果。方法选取2022年3月至2023年3月上饶市人民医院进行剖宫产术的148例产妇为研究对象,按照随机数字表法分为高剂量组(74例)和低剂量组(74例)。低剂量组注射用生理盐水稀释至150ml的1.5μg/kg的舒芬太尼+4mg的托烷司琼+0.1mg/kg的艾司氯胺酮,高剂量组注射用生理盐水稀释至150ml的1.5μg/kg的舒芬太尼+4mg的托烷司琼+0.2mg/kg的艾司氯胺酮。比较两组产妇术毕,术后1、2d时血流动力学[心率(HR)、平均动脉压(MAP)、血氧饱和度(SpO_(2))]、疼痛情况[McGill疼痛问卷(SF-MPQ)]差异,分析两组产妇麻醉相关不良反应发生差异。结果术后1、2d时,两组产妇的HR、MAP高于本组术毕时,高剂量组产妇的HR、MAP低于低剂量组,差异有统计学意义(P<0.05)。术后1d时,高剂量组产妇的SpO_(2),低于本组术毕时,差异有统计学意义(P<0.05)。术后1、2d时,低剂量组的SpO_(2),均低于本组术毕时,差异有统计学意义(P<0.05)。术后2d时,高剂量组产妇的SpO_(2),与本组术毕时比较,差异无统计学意义(P>0.05)。术后1、2d时,高剂量组产妇的SpO_(2),均高于低剂量组产妇,差异有统计学意义(P<0.05)。术后1、2d时,两组产妇的SF-MPQ评分均低于本组术毕时,且高剂量组产妇低于低剂量组,差异有统计学意义(P<0.05)。高剂量组的不良反应总发生率低于低剂量组,差异有统计学意义(P<0.05)。结论0.2mg/kg艾司氯胺酮复合舒芬太尼在剖宫产术后PCIA中的效果优于0.1mg/kg的艾司氯胺酮,能更有效维持血流动力学指标水平稳定,镇痛效果确切,安全性不受艾司氯胺酮剂量影响。

Objective To explore the application effect of different doses of Esketamine combined with Sufentanil on pa-tient-controlled intravenous analgesia(PCIA)after cesarean section.Methods A total of 148 puerperae who underwent ce-sarean section in Shangrao People's Hospital from March 2022 to March 2023 were selected as the study objects,and they were divided into high-dose group(74 cases)and low-dose group(74 cases)according to random number table method.The low-dose group was diluted with normal saline to 150 ml of 1.5μg/kg Sufentanil d+4 mg of Tropisetron+0.1 mg/kg Eske-tamine,and the high-dose group was diluted with normal saline to 150 ml of 1.5μg/kg Sufentanil+4 mg of Tropisetron+0.2 mg/kg Esketamine.The hemodynamics(heart rate[HR],mean arterial pressure[MAP],blood oxygen saturation[SpO_(2)])and pain status(short-form McGll pain questionnaire[SF-MPQ])were compared between the two groups at the end of surgery and at 1 and 2 day after surgery,and the differences in anesthesia-related adverse reactions in the two groups were analyzed.Results The HR and MAP in the two groups at 1 and 2 day after surgery were higher than those at the end of surgery,and the HR and MAP in high-dose group were lower than those in low-dose group,and the differences were statistically significant(P<0.05).The SpO_(2)in high-dose group at 1 day after surgery was lower than that at the end of surgery,and the difference was statistically significant(P<0.05).The SpO_(2),in low-dose group at 1 and 2 days after surgery was lower than that at the end of surgery(P<0.05).There was no statistical difference in SpO_(2)in high-dose group at 2 days after surgery compared with that at the end of surgery(P>0.05).The SpO_(2),in high-dose group was higher than that in low-dose group at 1 and 2 day after surgery,and the difference was statistically significant(P<0.05),The SF-MPQ scores in both groups were lower at 1 and 2 days after surgery than those at the end of surgery,and the scores in high-dose group were lower than those in low-dose group at 1 and 2 day after surgery,and the differences were statistically significant(P<0.05).The total incidence rate of adverse reactions in high-dose group was lower than that in low-dose group,and the difference was statistically significant(P<0.05).Conclu-sion The effect of 0.2 mg/kg Esketamine combined with Sufentanil in PCIA after cesarean section is better than that of 0.1 mg/kg Esketamine,and the former one can better maintain the hemodynamic indicator stability and has exact analgesic effect,and the safety is not affected by the dose of Esketamine.