硬膜外阻滞时氯胺酮对剖宫产产妇血流动力学及胎儿血气的影响

TheEHect of Ketamine on Maternal Hemodvnamics and Neonatal Blood gas Paramerters during Caesarean Section Under epidural Block

本文以正常足月妊娠产妇为对象，观察了在硬膜外阻滞下用氯胺酮对产妇血压、心率及胎儿血气的影响。１６例产妇随机分成二组（ｎ＝８），Ａ组：在硬膜外阻滞下单次静脉注射氯胺酮１．５ｍｇ／ｋｇ；Ｂ组：仅单次静脉注射氯胺酮１．５ｍｇ／ｋｇ。结果：二组于注氯胺酮后３、１０ｍｉｎ及胎儿娩出前ＭＡＰ、ＨＲ均显著升高，但Ｂ组ＭＡＰ、ＨＲ升高幅度及ＭＡＰ升高持续时间均显著大于Ａ组。二组间１ｍｉｎＡｐｇａｒ评分无显著性差异。与Ｂ组相比，Ａ组脐动脉血ｐＨ、ＰＯ２、ＳａＯ２、脐静脉血ＰＯ２、ＳａＯ２显著升高，胎儿氧摄取率显著下降。说明硬膜外阻滞可减轻氯胺酮对剖宫产产妇血流动力学的影响，并可改善氯胺酮对胎儿的不良影响。

ixteen cases of full term pregnat women undergoing caesarean section were randomly divided into twogroups:group A(n=8),receiving a single dose of ketamine 1.5mg/kg iv。during epidural block;group B(n=8),only 1.5mg/kg ketamine,The hemodynamic parameters were taken at 3,10 minutes after adiministration and be-fore fetal dlivery respectively,MAP,HR increased significantly in the two groups,but MAP,HR in group B in-creased more and lasted longer than that in group A. The neonatal 1 minute Apgar scores of the two groups werenot evidently different;PH,PO2,SaO2 increased markedly in group A,with significant decrease of oxygen uptakerate. It is suggested that epidural block may reduce the effect of ketamine on maternal hemodvnamincs and neona-tal blood gas parameters during caesarean section.