小剂量艾司氯胺酮复合丙泊酚对剖宫产 全麻的效果及对新生儿的影响

Effect of Low-dose Esmketamine Combined with Propofol in General Anesthesia for Cesarean Section and Its Effect on Newborns

摘要:

〔摘 要〕 目的：探讨剖宫产术应用小剂量艾司氯胺酮复合丙泊酚全身麻醉对产妇生命体征和新生儿的影响。方法： 选取 2019 年 1 月至 2019 年 12 月在焦作市妇幼保健院进行剖宫产术的 78 例产妇为研究对象，根据产妇是否存在硬膜 外麻醉禁忌证分组。选择其中硬膜外麻醉禁忌证的 39 例剖宫产产妇为观察组，采用小剂量艾司氯胺酮 0.3 mg·kg-1 、 丙泊酚 1.0 mg·kg-1、司可林 1.0 mg·kg-1 静脉注射，胎儿娩出后，追加芬太尼和苯磺顺阿曲库铵，并静脉持续泵入 丙泊酚维持麻醉。其余 39 例为对照组，行正常硬膜外麻醉。观察两组产妇麻醉效果及不良反应，产妇麻醉诱导至胎 儿娩出间隔时间（I–D），子宫切开至胎儿娩出间隔时间（U–D），产妇手术前后收缩压（SBP）、舒张压（DBP）、 心率（HR）、血氧饱和度（SpO2）等血流动力学变化、新生儿脐带血气分析及 Apgar 评分。结果：两组剖宫产术麻 醉平稳，术中产妇生命体征稳定。胎儿取出时，两组产妇 SBP、DBP、HR 水平均显著升高，且对照组比观察组升高 更为显著，差异均具有统计学意义（P ＜ 0.05）。新生儿 Apgar 评分均≥ 9 分。两组 I–D 和 U–D、Apgar 评分及新生 儿脐带血气分析值的差异均无统计学意义（P ＞ 0.05）。结论：小剂量艾司氯胺酮复合丙泊酚静脉麻醉能够满足剖宫 产手术要求，对母婴安全有效。

Abstract:

〔Abstract〕Objective To investigate the effect of low-dose esmketamine combined with propofol general anesthesia on maternal vital signs and newborns during cesarean section. Methods 78 pregnant women who underwent cesarean section in Jiaozuo Maternal and Child Health Hospital from January 2019 to December 2019 were selected as the research objects. They were grouped according to whether there were contraindications of epidural anesthesia. 39 cases of cesarean section women with contraindications of epidural anesthesia were selected as the observation group. They were injected intravenously with low-dose esmketamine 0.3 mg·kg-1, propofol 1.0 mg·kg-1 and skolin 1.0 mg·kg-1. After the fetus was delivered, fentanyl and cisatracurium besylate were added, and propofol was continuously pumped into the vein to maintain anesthesia. The other 39 cases were in the control group and underwent normal epidural anesthesia. The anesthetic effect and adverse reactions of the two groups were observed. The interval between induction of maternal anesthesia and delivery of fetus (I-D), the interval between incision of uterus and delivery of fetus (U-D), the hemodynamic changes of maternal systolic blood pressure (SBP), diastolic blood pressure (DBP), heart rate (HR), blood oxygen saturation (SpO2) before and after operation, neonatal umbilical cord blood gas analysis and Apgar score were observed. Results The anesthesia of cesarean section and the vital signs of pregnant women were stable in the two groups. When the fetus was removed, the levels of SBP, DBP and HR in the two groups increased significantly, and the levels of SBP, DBP and HR in the control group increased more significantly than those of in the observation group (P < 0.05). Neonatal Apgar scores were ≥ 9. There was no significant difference in I-D and U-D, Apgar score and neonatal umbilical cord blood gas analysis between the two groups (P > 0.05). Conclusion Intravenous anesthesia with low-dose esmketamine combined with propofol can meet the requirements of cesarean section, and is safe and effective for mothers and infants.