两种亚麻醉剂量氯胺酮在急症剖宫产中的应用

The clinic application of two subanesthestic dosages katamine in emergency caesarean section

目的:观察两种亚麻醉剂量氯胺酮在急症剖宫产中的临床应用效果。方法:60例初产妇,随机分为2组,均采用连续硬膜外麻醉,腹膜剪开前分别经静脉注射0.25、0.50mg/kg氯胺酮,记录2组产妇麻醉前后、手术开始时、静注氯胺酮10min后的收缩压(SBP)、舒张压(DBP)、心率(HR)、血氧饱和度(SpO2)、呼吸频率(RR),同时观察其意识、内脏牵拉反应、不良反应及新生儿Apgar评分。结果:2组间各时点SBP、DBP、HR、SpO2和RR比较差异均无统计学意义(P均>0.05)。2组组内比较,麻醉后、手术开始时SBP和DBP比麻醉前有不同程度下降,HR较麻醉前有不同程度升高,差异有统计学意义(P<0.05～0.01);静注氯胺酮10min后与其它各时点比较SBP、DBP、HR、RR均有不同程度升高(P<0.05～0.01)。2组间产妇不良反应发生率和1min、5min新生儿Apgar评分比较差异均无统计学意义(P>0.05)。结论:亚麻醉剂量氯胺酮作为硬膜外麻醉的辅助用药应用于剖宫产手术不仅有镇痛、镇静、催眠作用,且能有效减轻内脏牵拉反应,可改善麻醉效果,延长镇痛时间,对循环、呼吸功能影响小。

Objective: To obeserve the clinic effects of two subanesthestic dosages katamine in emergency caesarean section. Methods: 60 first-parturients, who were in continual epidural anaesthesia, were divided randomly to A group and B group.They were injected katamine of 0.25 or 0.5 mg/kg from vein before peritonaeum was cut out. Recorded systolic pressure(SBP), diastolic pressure(DBP), heart rate(HR), pulse oximetry(SpO\-2), respiratory rate(RR), and consciousness, harmful reactions of internal organs, respiratory depression of two groups and Apgar marks of newborn. Results: NO statistically significant difference was found about SBP、DBP、HR、SpO\-2 and RR of each time of two groups. A statistically significant reduction in different extent was found about SBP and DBP after anaesthesia and operation beginning compared to that before anaesthesia. A statistically significant rising in different extent was found about SBP and DBP in ten minutes after katamine injected compared to that in every time. A statistically significant rising in different extent was found about HR after anaesthesia and operation beginning compared to that before anaesthesia. NO statistically significant difference was found about harmful reactions of two groups and Apgar marks of newborn. Conclusions: Not only do subanesthestic dosage katamine have analgesia, sedation and hypnosis effects but also do they have the depressure effects to harmful reactions of internal organs, and approve the anaesthesia effect, and prolonge the analgesia time, and have a less effect to circulation and respiratory function when subanesthestic dosage katamine is as an adjuvant of epidural anaesthesia in caesarean section.