摘要
目的:研究艾司氯胺酮联合瑞马唑仑在剖宫产术全麻诱导中对产妇血流动力学以及母婴预后的影响。方法:选择2021年1月-2023年4月在本院接受剖宫产手术的产妇104例,随机数表法分为观察组和对照组各52例。对照组给予艾司氯胺酮+丙泊酚全麻,观察组给予艾司氯胺酮+瑞马唑仑全麻。比较两组产妇围术期凝血功能、术后痛觉过敏水平、应激反应、血流动力学和母婴预后。结果:平均动脉压(MAP)、心率(HR)及血氧饱和度(SpO_(2))的组间、时间点及交互差异均有统计学意义(P<0.05);胎儿娩出时观察组MAP(88.51±7.82 mmHg)、HR(83.21±12.38次/min)均低于对照组(101.42±8.25 mmHg、92.24±11.72次/min)、SpO_(2)(97.82±1.38)%高于对照组(95.41±1.75)%(均P<0.05);其余时刻两组MAP、HR及SpO_(2)比较无差异(P>0.05);术后,两组纤维蛋白原(Fbg)水平均降低,凝血酶原时间(PT)水平均升高,观察组Fbg水平高于对照组、PT水平低于对照组(均P<0.05);视觉模拟评分(VAS)和痛觉阈值在组间、时间点及交互差异均有统计学意义(P<0.05);术后15 min、30 min、1 h和2 h观察组VAS评分均低于对照组、痛觉阈值高于对照组;术后1d观察组去甲肾上腺素(NE)、促肾上腺皮质激素(ACTH)和皮质醇(Cor)水平均低于对照组(均P<0.05);两组新生儿血气指标和Apgar评分以及产妇不良事件发生率均无差异,两组新生儿新生儿神经退行性变生物标志物水平均无差异(P>0.05)。结论:艾司氯胺酮联合瑞马唑仑应用于剖宫产术中可预防产妇术后痛觉过敏,减轻术后应激和凝血功能障碍,减小血流动力学波动,对母婴预后无负面影响。
Objective:To study the effects of esketamine combined with remazolam for general anesthesia during cesarean section of women on their hemodynamic fluctuation and their maternal and infant prognosis.Methods:A total of 104 pregnant women who wanted cesarean section in the hospital were selected and were divided into study group and control group(52 cases in each group)by random number table method from January 2021 to April 2023.The women in the control group were given esketamine combined with propofol for general anesthesia,and the women in the study group were given esketamine combined with remazolam for general anesthesia.The perioperative coagulation function,the stress response and the hemodynamics indictors values,the level of postoperative hyperpain,and the maternal and infant prognosis of the women were compared between the two groups.Results:There were significant differences in the mean arterial pressure(MAP),the heart rate(HR)and the blood oxygen saturation(SpO_(2))of the women between the two groups,among the women with the different time points and interactions(P<0.05).The values of MAP(88.51±7.82 mmHg)and HR(83.21±12.38 beats/min)of the women in the study group were significantly lower than those(101.42±8.25 mmHg and 92.24±11.72 beats/min)of the women in the control group.The SpO_(2)value(97.82±1.38%)of the women in the study group was significantly higher than that(95.41±1.75%)of the women in the control group(all P<0.05).There were no significant differences in the values of MAP,HR and SpO_(2)of the women at other time points between the two groups(P>0.05).After operation,the fibrinogen(Fbg)level of the women in the two groups had decreased significantly,and the prothrombin time(PT)level of the women in the two groups had increased significantly.The Fbg level of the women in the study group was significantly higher than that of the women in the control group,and the PT level of the women in the study group was significantly lower(all P<0.05).There were significant differences in the visual analogue scale(VAS)score and the pain threshold of the women between the two groups,and among the women ate the different time points and interactions(P<0.05).At 15 min,30min,1h and 2h after operation,the VAS scores of the women in the study group were significantly lower than those of the women in the control group,and the pain threshold of the women in the study group was significantly higher than that of the women in the control group.The levels of norepinephrine(NE),adrenocorticotropic hormone(ACTH)and cortisol(Cor)of the women in the study group in 1 day after operation were significantly lower than those of the women in the control group(all P<0.05).There were no significant differences in the neonatal blood gas indexes,the levels of neonatal neurodegeneration biomarkers and the Apgar scores,and the incidence of the maternal adverse events of the women between the two groups(P>0.05).Conclusion:The application of esketamine combined with remazolam used in cesarean section of the pregnant women can prevent their postoperative pain hypersensitivity,relieve their postoperative stress and coagulation dysfunction,reduce their hemodynamic fluctuations,and without the negative effects on their newborns.
作者
孔贯祥
谢汝山
章颖
李敏
KONG Guanxiang;XIE Rushan;ZHANG Ying;LI Min(Shuyang Hospital of Traditional Chinese Medicine,Suqian,Jiangsu Province,223600;Shuyang Mercy Hospital,Suqian,Jiangsu Province)
出处
《中国计划生育学杂志》
2025年第9期1983-1988,1993,共7页
Chinese Journal of Family Planning
关键词
剖宫产术
全麻诱导
艾司氯胺酮
瑞马唑仑
血流动力学
母婴预后
Caesarean section
General anesthesia induction
Esketamine
Remazolam
Hemodynamics
Maternal and infant prognosis
