目的 分析艾司氯胺酮对剖宫产术后镇痛及肾素-血管紧张素-醛固酮系统（RAAS）、产后抑郁情况发生的影响。方法 研究对象为2020年5月—2021年6月在我院行剖宫产的96例孕产妇,根据麻醉药物的不同分为研究组50例和对照组46例,2组孕产妇均给予腰硬联合麻醉行剖宫产术,研究组于手术切皮前5 min静脉注射艾司氯胺酮0.2 mg/kg,对照组静脉注射等量生理盐水。比较2组孕产妇术后疼痛评分（VAS评分）、肾素活性（PRA）、血管紧张素-II（AT-II）、醛固酮（ALD）、爱丁堡产后抑郁量表（EPDS）、不良反应的发生情况。结果 与对照组比较,术后各时间点研究组孕产妇VAS评分均明显较低,差异具有统计学意义（P<0.01）。2组T1、T2、T3各时间点RAAS各指标均明显低于T0时间点（P<0.05）;研究组在T1、T2时间点RAAS各指标均明显低于对照组,差异具有统计学意义（P<0.05）。研究组术后3 d、术后6周EPDS评分均明显低于对照组（P<0.01）。2组不良反应总发生率比较无差异（P>0.05）。结论 艾司氯胺酮用于剖宫产术后镇痛效果显著,对产妇RAAS影响较小,并可缓解产妇抑郁症状,且不良反应发生率较低。

Objective To analyze the effect of esketamine on analgesia and renin angiotensin aldosterone system（RAAS）and the occurrence of postpartum depression after cesarean delivery．Methods The subjects were 96 pregnant women who underwent cesarean section in our hospital from May 2020 to June 2021,they were divided into 50 cases in the study group and 46 cases in the control group．Both groups of pregnant women were given combined spinal epidural anesthesia for cesarean section．The patients in study group were injected with esmketamine 0.2 mg/kg intravenously 5 minutes before skin incision,and those in control group were injected with the same amount of saline intravenously．The postoperative pain scores（VAS score）,plasma renin activity（PRA）,angiotensin-II（AT-II）,aldosterone（ALD）,Edinburgh Postpartum Depression Scale（EPDS）,and the occurrence of adverse effects were compared between the two groups．Results Compared with the control group,maternal VAS scores were significantly lower in the study group at all postoperative time points,and the differences were statistically significant（P<0.01）．The indexes of RAAS were significantly lower in both groups at T1,T2 and T3 time points than at T0 time point（P<0.05）;the indexes of RAAS were significantly lower in the study group at T1 and T2 time points than in the control group,and the differences were statistically significant（P<0.05）．The postoperative EPDS scores in the study group were significantly lower than those in the control group at 3 d and 6 weeks（P<0.01）．There was no difference in the overall incidence of adverse reactions between the two groups（P>0.05）．Conclusions Esketamine is effective for postoperative analgesia after cesarean section,with less effect on maternal RAAS,and can relieve maternal depressive symptoms,and has a low incidence of adverse reactions．

目的 探讨臂丛神经阻滞和关节腔内注射局麻药联合应用在肩关节镜手术中的应用价值。方法 对肩关节镜手术患者100例进行研究,2018年8月—2020年8月入组,根据随机数字表法分组处理,对照组和观察组各为50例,前者用臂丛神经阻滞,后者与关节腔内注射局麻药联合,比较2组麻醉效果、不同阶段疼痛程度、肩关节功能。另对比2组不良反应。结果 观察组麻醉起效时间、苏醒时间和拔管时间分别为(10.72±2.45)min、(8.21±1.32)min和(9.52±1.12)min,与对照组对应指标有差异(P<0.05);2组术前疼痛程度和肩关节功能对比无差异(P>0.05),观察组术后6 h、术后24 h和术后48 h疼痛评分依次为(1.31±0.27)分、(2.87±0.52)分和(3.44±0.42)分,术后6 h、术后12 h、术后24 h和术后48 h镇静评分分别为(2.92±0.32)分、(2.54±0.24)分、(2.38±0.12)分和(2.27±0.15)分,术后1周、1个月和3个月的肩关节功能评分分别为(50.12±4.54)分、(56.18±4.12)分和(73.16±4.78)分,较之于对照组有差异(P<0.05);对照组和观察组出现不良反应的概率分别为18.00%和4.00%(P<0.05)。 结论 在肩关节镜手术中联合应用臂丛神经阻滞联合关节腔内注射局麻药麻醉方式,可提高麻醉效果,术后镇痛和镇静效果明显,也可减少不良反应,对患者肩关节功能改善作用明显,存在广泛应用价值。

目的 比较不同浓度罗哌卡因横纹肌阻滞应用于剖宫产术后镇痛的临床效果。方法 选取2015年3月—2016年3月于我院剖宫产的孕妇300例,随机分为A组、B组、C组,每组100例,A组产妇给予质量浓度为1.5 g/L的罗哌卡因1.5 mg/kg,B组产妇给予质量浓度为2 g/L的罗哌卡因1.5 mg/kg,C组产妇给予质量浓度为2.5 g/L的罗哌卡因1.5 mg/kg,同时给予所有产妇镇痛泵辅助镇痛。记录观察所有产妇术后6 h、12 h、24 h、36 h、48 h的疼痛视觉模拟评分(VAS)、镇痛泵按压次数、产妇对镇痛效果的满意程度以及腹横肌平面阻滞(TAP)不良反应发生情况。结果 B、C组产妇的VAS评分均低于A组产妇(P＜0.05),24 h后C组产妇的VAS评分低于B组产妇(P＜0.05);与B、C组产妇相比,A组产妇的镇痛泵按压次数更多,镇痛效果满意度较低(P＜0.05),同时B组产妇的镇痛泵按压次数多于C组产妇(P＜0.05);3组产妇均未出现术后不良反应。结论 使用质量浓度为2.5 g/L的罗哌卡因横纹肌阻滞进行剖宫产术后镇痛,效果显著、安全性较高,临床中可推广使用。

Objective To compare the clinical effects of different concentrations of ropivacaine for postoperative analgesia after cesarean section. Methods 300 cases of pregnant women undergoing cesarean section in our hospital from March 2015 to March 2016 were selected and were randomly divided into group A, group B and group C with 100 cases in each group. The patients in group A were given 0.15% ropivacaine 1.5 mg/kg, 0.20% ropivacaine 1.5 mg/kg in group B and 0.25% ropivacaine 1.5 mg/kg in group C, and at the same time all the pregnant women were given analgesic pump assisting analgesia. The pain visual analogue scales (VAS) of the pregnant women were recorded at 6 hours, 12 hours, 24 hours and 36 hours after cesarean section and the number of times of analgesia pressing pump were also recorded. The satisfaction degree of analgesic effect and the TAP occurrence of adverse reactions of the patients were also recorded. Results The VAS scores of group B and group C were lower than that of group A(P<0.05). 24 hours after cesarean section, the VAS score of group C was lower than that of group B (P<0.05). Compared with group B and C, the number of times of analgesia pressing pump in group A were more but the analgesic effect of satisfaction was lower (P<0.05), and at the same time the number of times of analgesia pressing pump in group B were more than those in group C (P<0.05). No adverse reactions were found in the three groups. Conclusion The treatment of using of 0.25% of ropivacaine for muscle block for postoperative analgesia after cesarean section is effective and safe, which may be widely used in clinical practice.