广西医学

目的探讨小剂量艾司氯胺酮联合右美托咪定在剖宫产术后镇痛中的应用效果。方法将60例计划行剖宫产手术的产妇随机分为对照组和观察组，每组30例。剖宫产手术结束前10 min，给予两组产妇连接术后镇痛泵，其中对照组采用舒芬太尼1.0 μg/（kg·d）+纳布啡0.4 mg/（kg·d）进行镇痛，观察组采用艾司氯胺酮2.0 mg/（kg·d）+右美托咪定0.8 μg/（kg·d）进行镇痛。比较两组产妇剖宫产术后4 h（T1）、术后8 h（T2）、术后12 h（T3）、术后24 h（T4）和术后48 h（T5）的疼痛视觉模拟量表（VAS）评分，术后48 h内的追加镇痛次数及呕吐、血压升高、谵妄嗜睡、噩梦等镇痛相关不良反应的发生情况。结果两组产妇的疼痛VAS评分差异有统计学意义（P<0.05），两组的疼痛VAS评分有随时间变化的趋势（P<0.05），疼痛VAS评分的分组与时间存在交互效应（P<0.05）；其中，两组的疼痛VAS评分呈现先升高后降低的趋势（P<0.05），且观察组T2、T3、T4的疼痛VAS评分低于对照组（P<0.05）。观察组产妇的术后追加镇痛次数少于对照组（P<0.05）。两组产妇术后呕吐发生率差异无统计学意义（P>0.05），且均未出现血压升高、谵妄嗜睡、噩梦等镇痛相关不良反应。结论相较于常规镇痛用药（舒芬太尼联合纳布啡），小剂量艾司氯胺酮联合右美托咪定对剖宫产术后产妇的镇痛效果更佳，且安全性相当。

Objective To explore the application effect of low⁃dose esketamine combine with dexmedetomidine in postoperative analgesia after Cesarean section. Methods A total of 60 puerperae who planned to undergo Cesarean section were randomly divided into control group or observation group, with 30 cases in each group. Ten minutes before the end of Cesarean section, the puerperae of the two groups were connected to the postoperative analgesia pump, among which the control group was given sufentanil 1.0 μg/ (kg·d)+nalbuphine 0.4 mg/ (kg·d) for analgesia. The observation group was treated with esketamine 2.0 mg/(kg·d)+dexmedetomidine 0.8 μg/(kg·d) for analgesia. Visual Analogue Scale (VAS) scores at 4 hours (T1), 8 hours (T2), 12 hours (T3), 24 hours (T4) and 48 hours (T5) after Cesarean section were compared between the two groups. The occurrence of analgesia⁃related adverse reactions such as the number of additional analgesia, vomiting, elevated blood pressure, delirium and drowsiness, and nightmares within 48 hours after operation were also compared between the two groups. Results There was a statistically significant difference in VAS score for pain between the two groups (P<0.05), and VAS score for pain of the two groups had a trend of change with time (P<0.05). There was an interaction effect between the group of VAS score for pain and time (P<0.05). VAS scores for pain of the two groups exhibited a trend of increasing first and then decreasing (P<0.05), and VAS scores for pain of the observation group at T2, T3 and T4 were lower than those of the control group (P<0.05). The number of additional postoperative analgesia in the observation group was less than that in the control group (P<0.05). There was no statistically significant difference in the incidence rate of vomiting between the two groups (P>0.05). There was no analgesia⁃related adverse reaction such as elevated blood pressure, delirium and drowsiness, and nightmares. Conclusion Compared with conventional analgesics (sufentanil combined with nalbuphine), low⁃dose esketamine combined with dexmedetomidine for Cesarean section has better postoperative analgesic effect and equivalent safety in puerperae.