The Effect of Ropivacaine Hydrochloride Combined with Esketamine on Perioperative Mother and Baby during Cesarean Section under Spinal Anesthesia
Objective:To explore the safety and effectiveness of Ropivacaine Hydrochloride combined with Esketamine for spinal anesthesia during cesarean section,as well as its impact on neonatal Apgar score,postoperative analgesia,and depression in postpartum women.Method:A total of 300 postpartum women who underwent elective transverse incision cesarean section under lumbar anesthesia at the People's Hospital of Jiuquan from November 2021 to October 2022 were selected.The parturients were randomly divided into five groups:the 0.5%equal proportion Ropivacaine Hydrochloride 10 mg combined with Esketamine 15 mg group(LA1 group),the 0.5%equal proportion Ropivacaine Hydrochloride 10 mg combined with Esketamine 12.5 mg group(LA2 group),0.5%equal gravity Ropivacaine Hydrochloride 10 mg combined with Esketamine 10 mg group(LA3 group),0.5%equal gravity Ropivacaine Hydrochloride 10 mg combined with Esketamine 7.5 mg group(LA4 group),and 0.5%equal gravity Ropivacaine Hydrochloride 10 mg group(control group,L group),with 60 cases in each group.The MAP,HR,and SpO2 of the pregnant woman before anesthesia(baseline value,T0),1,3,5,10 min after anesthesia(T1,T2,T3,T4),1,3,5,10 min after fetal removal(T5,T6,T7,T8),and at the end of surgery(T9)were recorded.Acupuncture method was used to evaluate the onset and duration of sensory blockade,the level of anesthesia block,the rate of reaching T4 level,and the time of reaching peak level;the onset and duration of motor block were evaluated using the modified Bromage scale(MBS);the newborns Apgar scores at 1,5,10 min were recorded;the occurrence of adverse reactions and complications during the perioperative period were recorded;postoperative VAS scores,Ramsay sedation scores,and PCEA compression at 4,8,12,24,48 h were recorded;the depression level of the postpartum woman 1 day before surgery and 3 and 7 days after surgery were recorded simultaneously.Result:There was no statistically significant difference in the incidence of nausea and vomiting among the five groups(P>0.05).The Apgar scores of the five groups of newborns at 1,5,10 min after birth were all 8-10 points,the differences were not statistically significant(P>0.05).The incidence of dizziness in the LA1 group was significantly higher than that in the L group(P<0.05);the incidence of shivering in the LA1 group was significantly lower than that in the L group(P<0.05);the incidence of traction reaction in the LA1 group was significantly lower than that in the L group(P<0.05).Compared with T0,the levels of MAP of the LA1 group were significantly reduced at T1,T2,T3,T5,T6,T7(P<0.05);the levels of MAP of the LA2 group and LA3 group decreased significantly at T1,T2,T3,T5,T6(P<0.05);the levels of MAP of LA4 group decreased significantly at T1 T2,T3,T5(P<0.05);the levels of MAP of L group were significantly reduced at T1,T2,T3,T5,T6(P<0.05).Compared with T0,there was no statistically significant difference in HR between the LA1 group,LA2 group,LA3 group,and LA4 group from T1 to T9(P>0.05);the HR of L group significantly increased at T2,T3 and T5(P<0.05).There was no statistically significant difference in SpO2 among the five groups at different times(P>0.05).Compared with L group,there was no statistically significant difference in MAP between LA1 group,LA2 group,LA3 group,and LA4 group from T1 to T9(P>0.05);the HR of L group increased significantly faster than that of LA1 group at T2(P<0.05);At T2 and T3,the HR of L group increased significantly faster than those of LA2 group,LA3 group,and LA4 group(P<0.05).The onset time of sensory blockade in the LA1 group was significantly earlier than that in the LA4 group and L group(P<0.05),and the LA2 group was significantly earlier than that in the L group(P<0.05).The duration of sensory blockade in the LA1 group was significantly shorter than that in the L group(P<0.05).The onset time of motor block in the LA1 group was significantly earlier than that in the LA4 group and L group(P<0.05),and that in the LA2 group was significantly earlier than that in the L group(P<0.05).The duration of motor block increased sequentially among the five groups,but the difference was not statistically significant(P>0.05).The rate of anesthesia block level reaching T4 was significantly higher in the LA1 group than that in the L group(P<0.05).The peak time of anesthesia block level in LA1 group and LA2 group were significantly shorter than that in L group(P<0.05).At 4,8,12,24,and 48 hours after surgery,the VAS scores of LA1 group,LA2 group,LA3 group,and LA4 group were significantly lower than those of L group(P<0.05).The Edingburgh postnatal depression scale(EPDS)scores of LA1 group,LA2 group,LA3 group and LA4 group were significantly lower at 3 and 7 days after surgery than those of L group and 1 day before surgery(P<0.05).The PCEA pressing frequency of LA1 group and LA2 group was significantly lower than that of L group(P<0.05),while LA1 group was significantly lower than LA4 group(P<0.05).Conclusion:Ropivacaine Hydrochloride combined with Esketamine spinal anesthesia can be safely used for cesarean section,the anesthesia effect is significantly improved,the recovery of postpartum movement is accelerated,and it does not cause a decrease in Apgar score of newborns.It can effectively prevent shivering reactions after cesarean section,reduce the number of PCEA compressions after surgery,and significantly reduce the degree of postoperative movement pain and early postpartum depression in postpartum women.The combination of 10 mg Ropivacaine Hydrochloride and 12.5 mg Esketamine is more stable in terms of safety and efficacy after spinal anesthesia for cesarean section.
万方数据
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