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| 艾司氯胺酮在硬膜外阻滞剖宫产术中的效果 |
| Effect of esketamine on cesarean section under epidural anesthesia |
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| DOI：10.12089/jca.2023.11.008 |
| 中文关键词: 艾司氯胺酮 硬膜外阻滞 剖宫产 牵拉反应 不良反应 |
| 英文关键词: Esketamine Epidural anesthesia Cesarean section Visceral traction reaction Adverse effects |
| 基金项目:贵州省科学技术基金项目（gzwkj2022-380） |
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| 中文摘要: |
目的 观察艾司氯胺酮辅助硬膜外阻滞用于剖宫产术的效果及对母婴结局的影响。
方法 选择择期硬膜外阻滞下行择期剖宫产术足月单胎产妇90例，年龄20～40岁，BMI 18～35 kg/m2，ASA Ⅱ级。采用随机数表法将产妇分为两组：艾司氯胺酮组（K组）和对照组（C组），每组45例。硬膜外阻滞后，在切皮前1 min，K组静脉注射艾司氯胺酮0.15 mg/kg，C组静脉注射等容量生理盐水。记录术中产妇牵拉反应情况，胎儿娩出后1、5 min Apgar评分。采集新生儿断脐后、脐带结扎前的脐静脉血，记录新生儿脐静脉血pH、二氧化碳分压（PCO2）、氧分压（PO2）、乳酸（Lac）。记录产妇术中恶心、呕吐、幻觉、头晕、噩梦等不良反应发生情况。
结果 与C组比较，K组产妇术中牵拉反应发生率明显降低（P<0.05）。两组新生儿1、5 min Apgar评分和脐静脉血pH、PCO2、PO2、Lac差异无统计学意义。两组产妇恶心、呕吐、头晕发生率差异无统计学意义。两组产妇均未出现幻觉、噩梦等不良反应。
结论 艾司氯胺酮0.15 mg/kg能有效减少硬膜外阻滞剖宫产术中的牵拉反应，未增加产妇恶心、呕吐、头晕、幻觉、噩梦等不良反应，对新生儿Apgar评分及血气分析结果无明显影响，母婴结局安全。 |
| 英文摘要: |
Objective To evaluate the effect of esketamine for cesarean section under epidural anesthesia and maternal and fetal outcome.
Methods The parturients all were singleton pregnancies at term and scheduled for elective cesarean delivery. Ninety parturients undergoing elective cesarean delivery under epidural anesthesia, aged 20-40 years, BMI 18-35 kg/m2, ASA physical status Ⅱ, were randomly allocated into two groups: esketamine group (group K) and control group (group C), 45 cases in each group. When the targeted upper sensory block level was achieved, esketamine 0.15 mg/kg was administered intravenously for 1 minute before skin incision in group K, the same volume of normal saline was intravenously injected in group C. Visceral traction reaction during the operation was recorded. Apgar score was assessed 1 minute and 5 minutes after birth. The pH value, partial pressure of carbon dioxide, oxygen partial pressure, and lactic acid value of the neonatal umbilical vein blood were recorded. Adverse events such as nausea, vomiting, hallucination, dizziness and nightmare were monitored in the two groups.
Results Compared with group C, visceral traction reaction was significantly lower in group K (P < 0.05). The neonatal Apgar score, pH value, carbon dioxide partial pressure, oxygen partial pressure, and lactic acid value of the neonatal umbilical vein blood did not differ between the two groups. There were no differences in the incidence of nausea, vomiting and dizziness between the two groups. Hallucinations and nightmares were not encountered in either group.
Conclusion Esketamine 0.15 mg/kg can effectively reduce visceral traction reaction during cesarean delivery under epidural anesthesia. There was no significant effect on neonatal Apgar score and blood gas analysis, with no noticeable maternal and neonatal adverse effect. |
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