摘要
目的分析艾司氯胺酮对二次剖宫产术后静脉自控镇痛(patient controlled intravenous analgesia,PCIA)效果及恢复质量的影响。方法选取2021年2月—2022年12月择期在郑州市金水区总医院行椎管内麻醉下二次剖宫产的产妇164例,按PCIA药物不同,将术后采用艾司氯胺酮+托烷司琼+酮咯酸氨丁三醇进行PCIA的82例作为艾司氯胺酮组,将术后采用舒芬太尼+托烷司琼+酮咯酸氨丁三醇进行PCIA的82例作为舒芬太尼组。比较两组术后2、6、12、24、48 h切口视觉模拟疼痛评分及Ramasy镇静评分,术后早期恢复情况,补救镇痛率,48 h内PCIA按压次数及治疗期间不良反应发生情况。结果两组术后2、6、12、24、48 h切口VAS评分及Ramasy镇静评分呈先升高后降低趋势(P<0.05),但两组不同时间点的切口VAS评分及Ramasy镇静评分比较,差异无统计学意义(P>0.05);艾司氯胺酮组术后24 h及48 h 40项恢复质量量表(QoR40)评分中身体舒适度、自理能力、心理支持、情绪状态评分及总分较舒芬太尼组均更高(P<0.05);艾司氯胺酮组术后48 h内有效PCIA按压次数及补救镇痛率(12.20%)与舒芬太尼组(17.07%)比较,差异无统计学意义(P>0.05);艾司氯胺酮组总不良反应发生率40.24%低于舒芬太尼组的80.49%(P<0.05)。结论在二次剖宫产术后PCIA中应用艾司氯胺酮及舒芬太尼均可获得较好的镇痛镇静效果,但相较于应用舒芬太尼,应用艾司氯胺酮可使产妇得到更好地术后恢复,且总不良反应发生率更低。
Objective To analyze the effects of esketamine on the efficacy and recovery quality of patient controlled intravenous analgesia(PCIA)after secondary cesarean section.Methods A total of 164 puerperae who underwent a second cesarean section under epidural anesthesia in Zhengzhou Jinshui District General Hospital from February 2021 to December 2022 were selected,and the patients were divided into two groups by random number table method:esketamine group and sufentanil group group,with 82 cases in each group.The esketamine group received PCIA with esketamine+tropisetron+ketorolac tromethamine,while the sufentanil group received postoperative sufentanil+tropisetron+ketorolac tromethamine,alcohol for PCIA.The incision visual analog pain score and Ramasy sedation score at 2,6,12,24,and 48 hours after operation,the early postoperative recovery,the number of effective PCIA compressions and the rescue analgesia rate within 48 hours after operation were compared between the two groups.The occurrence of adverse reactions during treatment in the two groups was observed and recorded.Results At 2,6,12,24,and 48 hours after operation,the incision VAS score and Ramasy sedation score in the two groups increased first and then decreased(P<0.05),and there were differences in the incision VAS score and Ramasy sedation score between the two groups at different time points,but no statistical significance(P>0.05).The scores of emotional state,psychological support,self-care ability,physical comfort and total score of the 40-item Quality of Recovery Scale(QoR40)scores in the esketamine group at 24 h and 48 h after operation were higher than those of group sufentanil(P<0.05).There was no difference significant between the esketamine group and the sufentanil group(17.07%)in the number of effective PCIA compressions and rescue analgesia rate within 48 hours after operation(P>0.05).The incidence of adverse reactions in esketamine group was 40.24%lower than that of Sufentanil group(80.49%)(P<0.05).Conclusion Both esketamine and sufentanil can achieve better analgesic and sedative effects in PCIA after secondary cesarean section,but compared with sufentanil,esketamine can make puerpera better postoperative recovery,and the incidence of nausea,vomiting and pruritus is lower.
作者
冯炎超
常超男
李彬
FENG Yan-chao;CHANG Chao-nan;LI Bin(Department of Anesthesiology,Zhengzhou Jinshui District General Hospital,Zhengzhou 450000,China;The Second Affiliated Hospital of Zhengzhou University,Zhengzhou 450000,China)
出处
《医药论坛杂志》
2024年第11期1185-1189,共5页
Journal of Medical Forum
关键词
二次剖宫产
静脉自控镇痛
艾司氯胺酮
舒芬太尼
Second cesarean section
Patient controlled intravenous analgesia
Esketamine
Sufentanil
