摘要
目的评价围手术期应用艾司氯胺酮对剖宫产手术后产妇急性和慢性疼痛的影响。方法选择2021年5月至11月无锡市锡山人民医院在蛛网膜下腔阻滞下择期行子宫下段剖宫产术的产妇150例,采用随机数字表法分为两组(n=75):艾司氯胺酮组(E组)和对照组(C组)。采用重比重布比卡因(3.33%葡萄糖配置)9~11 mg行蛛网膜下腔阻滞。待胎儿娩出后,E组立即静脉泵注艾司氯胺酮0.15 mg/kg,浓度为1 mg/ml,泵注时间为30 min,C组则静脉泵注同等剂量的生理盐水30 min。术毕开启PCIA泵,E组镇痛泵配置为舒芬太尼100μg+艾司氯胺酮1.25 mg/kg+昂丹司琼8 mg,生理盐水稀释至100 ml;C组镇痛泵配置为舒芬太尼100μg+昂丹司琼8 mg。记录给药后即刻、给药后5、15 min和30 min的HR、SBP和DBP;记录术后2、6、12、24 h和48 h静息及咳嗽疼痛数字评价量表(NRS)评分;记录术后0~12 h、12~24 h、24~48 h、0~24 h和0~48 h舒芬太尼消耗量和首次镇痛时间;随访术后3、6个月慢性疼痛及不良反应发生率。结果两组产妇在给药即刻、给药后5、15 min和30 min的HR、SBP和DBP比较差异均无统计学意义(均P>0.05)。E组术后2、6、12 h静息、咳嗽NRS评分明显低于C组(均P<0.05);与C组相比,E组首次镇痛时间明显延长[(176.8±18.3)min vs(148.5±16.9)min,P<0.05],E组术后0~12 h、12~24 h、0~24 h和0~48 h舒芬太尼消耗量显著低于C组(均P<0.05),但术后24~48 h两组间差异无统计学意义(P>0.05)。两组术后3、6个月不良反应发生率比较差异无统计学意义(均P>0.05)。E组术后3个月[13.4%(9/67)vs 18.8%(13/69),P=0.392]和6个月[10.7%(6/56)vs 16.1%(10/62),P=0.391]慢性疼痛发生率与C组比较,差异均无统计学意义。结论围手术期应用艾司氯胺酮可优化剖宫产术后短期镇痛效果,且不增加精神反应,但不能预防慢性疼痛的发生。
Objective To evaluate the effectiveness of esketamine during perioperative anesthesia for acute and chronic pain after cesarean section.Methods One hundred and fifty patients scheduled for elective cesarean section under spinal anesthesia were randomly assigned into 2 equal groups(n=75)using a random number table:esketamine group(group E)and control group(group C).Subarachnoid block was administered with 9-11 mg of hyperbaric bupivacaine with 0.33% glucose concentration.After the delivery of the fetus,0.15 mg/kg(1 mg/ml)esketamine was pumped intravenously for 30 min in the group E,while the same dosage of normal saline was administered in the group C.Furthermore,patients received an intravenous patient controlled intravenous analgesia(PCIA)pump after surgery(100μg sufentanil+1.25 mg/kg esketamine+8 mg ondansetron for the group E,100μg sufentanil+8 mg ondansetron for the group C).Heart rate(HR),systolic blood pressure(SBP),and diastolic blood pressure(DBP)were recorded in the initial time of esketamine administration,and 5,15 min,and 30 min after administration.The pain Numerical Rating Scale(NRS)score at rest and during coughing were recorded at 2,6,12,24 h and 48 h after surgery.The first analgesic time and cumulative sufentanil consumption were recorded at 0-12 h,12-24 h,24-48 h,0-24 h and 0-48 h after surgery.Moreover,we recorded the incidence of chronic pain at 3 and 6 months after surgery.Results There were no significant differences in HR,SBP and DBP between the two groups immediately after administration of esketamine and 5,15 min and 30 min after administration(all P>0.05).At rest or during coughing,the pain NRS score were significantly lower at 2,6 h,and 12 h postoperatively in group E compared to group C(all P<0.05).The time to first analgesia in group E was significantly longer than the group C[(176.8±18.3)min vs(148.5±16.9)min,P<0.05].The cumulative sufentanil consumption was significantly lower in group E during 0-12 h,12-24 h,0-24 h and 0-48 h postoperatively than in group C(all P<0.05),but ther
作者
宗乾坤
丁丽丽
宋雪
唐丽
孙兴兵
刘清仁
Zong Qiankun;Ding Lili;Song Xue;Tang Li;Sun Xingbing;Liu Qingren(Department of Anesthesiology,Xishan People's Hospital of Wuxi,Wuxi 214105,China)
出处
《中国医师杂志》
CAS
2023年第4期570-574,共5页
Journal of Chinese Physician
基金
无锡市"双百"中青年医疗卫生拔尖人才(HB2020112)
无锡市科技发展医疗卫生项目(NZ2021035)。
关键词
氯胺酮
剖宫产术
疼痛
手术后
Ketamine
Cesarean section
Pain,postoperative
