摘要
目的观察瑞马唑仑联合艾司氯胺酮辅助用药对剖宫产手术麻醉效果和精神症状的影响。方法选择在腰-硬联合麻醉下行剖宫产的足月妊娠产妇96例,年龄24~38岁,BMI 24~35 kg/m^(2),ASAⅠ或Ⅱ级。采用随机数字表法将产妇分为三组:瑞马唑仑联合艾司氯胺酮组(RK组)、艾司氯胺酮组(K组)和对照组(C组),每组32例。胎儿娩出后,RK组静脉注射瑞马唑仑0.1 mg/kg,然后静脉泵注艾司氯胺酮0.25 mg/kg(加生理盐水稀释至20 ml静脉泵注,30 min内泵完);K组仅静脉泵注艾司氯胺酮0.25 mg/kg(加生理盐水稀释至20 ml静脉泵注,30 min内泵完);C组给予等容量生理盐水。所有患者术毕行PCIA。观察胎儿娩出至术毕的麻醉效果(Ⅰ级,无疼痛感;Ⅱ级,有轻微疼痛感;Ⅲ级,有明显疼痛感)。记录术中高血压、心动过速、精神症状(眼球震颤、头晕、噩梦和幻觉)等不良反应发生情况。采用爱丁堡产后抑郁量表(EPDS)评估产妇术后1周和4周的抑郁状态评分及产后抑郁(PPD)的发生情况(EPDS评分≥12分)。结果与C组比较,RK组和K组术中麻醉效果Ⅰ级比例明显升高,Ⅲ级比例明显降低(P<0.05),术后1周和4周EPDS评分及PPD发生率明显降低(P<0.05)。与K组比较,RK组术中精神症状发生率明显降低(P<0.05),术后1周和4周EPDS评分明显降低(P<0.05)。三组高血压、心动过速发生率差异无统计学意义。结论瑞马唑仑联合艾司氯胺酮用于剖宫产手术可提高术中麻醉效果,降低术中精神症状等不良反应发生率,降低产后EPDS评分,改善PPD。
Objective To investigate the effect of remimazolam combined with esmketamine adjuvant medicines on anaesthetic effect and mental symptom in puerperae undergoing cesarean section.Methods Ninety-six full-term puerperae during cesarean section under combined spinal-epidural anesthesia,aged 24-38 years,BMI 24-35 kg/m^(2),ASA physical statusⅠorⅡ.All the puerperae were divided into three groups using random number table:remimazolam combined with esketamine group(group RK),esketamine group(group K),and control group(group C),32 puerperae in each group.After the delivery of the fetus,puerperae in group RK were given intravenous injection of remimazolam 0.1 mg/kg,and then intravenous pumping of estaketamine 0.25 mg/kg which was diluted to 20 ml with normal saline(finished in 30 minutes),puerperae in group K were given intravenous pumping of estaketamine 0.25 mg/kg which was diluted to 20 ml with normal saline(finished in 30 minutes),puerperae in group C were given the same dose of normal saline.All puerperae were given PCIA after operation.The anesthetic effect from the fetus delivery to the end of operation were recorded(gradeⅠ,no pain;gradeⅡ,slight pain;gradeⅢ,with significant pain).The adverse reactions such as hypertension,tachycardia,and mental symptoms(nystagmus,dizziness,nightmares and hallucinations)during surgery were recorded.The score of Edinburgh postpartum depression scale(EPDS)and incidence of postpartum depression(PPD)at 1 week and 4 weeks after surgery were recorded.Results Compared with group C,the proportion of gradeⅠanesthetic effect in groups,RK and K was significantly increased,and the proportion of gradeⅢanesthetic effect was significantly decreased(P<0.05),the EPDS score and the incidence of PPD were significantly decreased at 1 week and 4 weeks after surgery(P<0.05).Compared with group K,the incidence of mental symptoms during surgery in group RK was significantly decreased(P<0.05),EPDS score was significantly decreased at 1 week and 4 weeks after surgery(P<0.05).There were no signifi
作者
邵先红
朱勃朗
王纯辉
常俊
李元海
SHAO Xianhong;ZHU Bolang;WANG Chunhui;CHANG Jun;LI Yuanhai(Department of Anesthesiology,the First Affiliated Hospital of Anhui Medical University,Hefei 230012,China)
出处
《临床麻醉学杂志》
CAS
CSCD
北大核心
2024年第7期719-722,共4页
Journal of Clinical Anesthesiology
基金
炎症免疫性疾病安徽省实验室开放基金(IMMDL202006)。
关键词
瑞马唑仑
艾司氯胺酮
剖宫产
麻醉效果
精神症状
产后抑郁
Remimazolam
Esketamine
Cesarean section
Anesthetic effect
Mental symptom
Postpartum depression
