不同剂量艾司氯胺酮联合超声引导腹横肌平面阻滞在急诊剖宫产术中的麻醉效果及安全性

Anesthetic efficacy and safety of varying doses of esketamine combined with ultrasound-guided transversus abdominis plane block in emergency cesarean section

摘要:

目的 探讨不同剂量艾司氯胺酮联合超声引导腹横肌平面阻滞在急诊剖宫产术中的麻醉效果及安全性。方法 选取2024年2月—2026年2月绵阳四〇四医院收治的116例急诊剖宫产产妇，采用随机数字表法分为对照组与观察组，每组58例。对照组给予艾司氯胺酮0.50 mg/kg联合腹横肌平面阻滞，观察组给予艾司氯胺酮0.75 mg/kg联合腹横肌平面阻滞。比较两组产妇的麻醉阻滞效能指标（麻醉起效时间，最高阻滞平面时间）、镇痛效果［术后6、24、48 h静息状态下的视觉模拟评分法（VAS）评分］、应激反应指标［去甲肾上腺素（NE）、皮质醇（Cor）、白细胞介素-6（IL-6）］、术后恢复情况（首次肛门排气时间、首次下床活动时间、术后住院时间）、新生儿结局指标（新生儿娩出后1、5 min的Apgar评分）及不良反应发生情况。结果 观察组产妇的麻醉起效时间及最高阻滞平面时间均短于对照组（P <0.05）。两组产妇术后6、24、48 h静息状态下VAS评分比较，采用重复测量设计的方差分析，结果 ①不同时间点的VAS评分比较，差异有统计学意义（P <0.05）；②两组的VAS评分比较，差异有统计学意义（P <0.05），观察组VAS评分低于对照组，表明镇痛效果更佳；③两组VAS评分变化趋势比较，差异有统计学意义（P <0.05）。观察组产妇的NE、Cor、IL-6差值均小于对照组（P <0.05）。观察组产妇首次肛门排气时间、首次下床活动时间及住院时间均短于对照组（P <0.05）。两组新生儿的1、5 min Apgar评分差值比较，差异无统计学意义（P >0.05）。两组产妇的不良反应总发生率比较，差异无统计学意义（P >0.05）。结论 0.50 mg/kg与0.75 mg/kg艾司氯胺酮联合腹横肌平面阻滞均适用于急诊剖宫产，其中0.75 mg/kg剂量在提供更优镇痛效果及抑制应激反应方面更具优势，且未增加不良反应风险，临床应用安全有效。

Abstract:

Objective To assess the efficacy and safety of varying doses of esketamine combined with ultrasound-guided transversus abdominis plane (TAP) block in emergency cesarean delivery.Methods A total of 116 parturients undergoing emergency cesarean section between February 2024 and February 2026 were randomly allocated into a control group (n = 58), receiving esketamine 0.50 mg/kg plus TAP block, and an observation group (n = 58), receiving esketamine 0.75 mg/kg plus TAP block. Anesthetic onset, time to achieve peak sensory block, postoperative pain scores, stress-related biomarkers, recovery indices, neonatal outcomes, and adverse events were evaluated and compared.Results The anesthesia onset time and time to achieve the highest sensory block level were shorter in the observation group than in the control group (P < 0.05). Resting VAS scores at 6, 24, and 48 hours postoperatively were compared using repeated-measures analysis of variance. The results showed: (1) significant differences in VAS scores across different time points (P < 0.05); (2) a significant difference between the two groups (P < 0.05), with the observation group exhibiting significantly lower VAS scores than the control group, indicating superior analgesic efficacy; and (3) a significant interaction effect between time and group (P < 0.05), suggesting that the changes in VAS scores over time differed between the two groups. The changes in norepinephrine (NE), cortisol (Cor), and interleukin-6 (IL-6) were smaller in the observation group than in the control group (P < 0.05). The time to first postoperative flatus, time to ambulation, and length of hospital stay were shorter in the observation group (P < 0.05). No significant differences were found in the change of Apgar scores from 1 min to 5 min between the two groups (P > 0.05). There was no significant difference in the incidence of adverse events between the two groups (P > 0.05).Conclusion Esketamine at doses of 0.50 mg/kg and 0.75 mg/kg combined with TAP block is applicable for emergency cesarean section. The 0.75 mg/kg regimen provides better analgesia and blunts the surgical stress response without increasing the incidence of adverse events, supporting its safety and efficacy.