术前辅助小剂量氯胺酮在全身麻醉剖宫产术对产妇和新生儿的影响

摘要

目的：探讨小剂量氯胺酮术前用于全身麻醉剖宫产术对产妇安全性和有效性及对新生儿的影响。方法将足月孕产妇80例随机分为氯胺酮组（K组）和生理盐水组（S组），每组各40例。K组产妇在麻醉诱导前静脉给予0.5mg/kg氯胺酮5ml；S组给予生理盐水5ml。产妇气管插管后给予纯氧和2%七氟烷机械通气。当新生儿娩出后给予产妇咪达唑仑和舒芬太尼。术中维持听觉诱发电位指数值（AAI）20~30。记录产妇诱导前（T0）、诱导后1min（T1）、诱导后3min（T2）、诱导后5min（T3）、诱导后10min（T4）、诱导后30min（T5）、手术结束（T6）产妇的血流动力学变化，记录术后恶心呕吐和不良精神反应；采集新生儿脐静脉进行血液分析（pH值，氧分压，二氧化碳分压），并对其娩出后1、5min进行Apgar评分。结果血压及心率在麻醉诱导前及诱导后1min两组无明显差异（P>0.05）；在诱导后3、5、10、30min及手术结束：S组均显著高于K组（P<0.05）。产妇术后不良反应无明显差异（P>0.05）。新生儿脐静脉血气分析无明显差异（P>0.05）；娩出后1min Apgar评分K组高于S组（P<0.05），5min Apgar评分无明显差异（P>0.05）。结论剖宫产全身麻醉静脉诱导前注射0.5mg/kg氯胺酮作为辅助镇痛、镇静可以安全有效的使用，不会对新生儿产生影响。%ObjectiveTo investigate the efficacy and safety of low dose ketamine on maternal and the effect on newborn during caesarean section under general anaesthesia.Methods80 cases of term pregnant women were randomly divided into ketamine group(K group)and normal saline group(S group),40 cases in each group.In group K,5ml of 0.5mg/kg of ketamine was injected before induction of anesthesia.In group S, while 5ml of Saline solution was injected.After intubation,maternals were ventilated with O2 and 2% sevoflurane.Midazolam and sufentanil were given following delivery of the baby.AAI value was maintained at 20-30 during surgery.The hemodynamic changes of maternals before induction(T0), one minute after induction(T1),three minutes after induction(T2),5 minutes after the induction(T3),10 minutes after the induction (T4),30 minutes after induction(T5),the end of surgery(T6)were recorded,and aslo postoperative nausea and vomiting and adverse mental reactions.Umbilical vein blood samples were collected(pH,pO2,pCO2).Apgar score at 1 min and 5 min were recorded.ResultsPreinduction haemodynamic parameters and heart rate recorded at 1 min after induction were comparable in both groups(P>0.05).However,3,5,10,30 minutes after intubation and the end of surgery:S group were significantly higher than K group(P<0.05).Postoperative adverse reactions was no significant difference(P>0.05).Umbilical venous blood gas analysis was no significant difference(P>0.05).Though Apgar score at 1 min showed a higher scoring in Group K(P<0.05),at 5 min both groups had comparable scores.Conclusion IV ketamine 0.5mg/kg can be safely used to attenuate haemodynamic responses during caesarean section under general anaesthesia without affecting the newborns outcome.