小剂量氯胺酮咪唑安定辅助硬膜外下剖腹产手术的临床探讨

Treatment of the Traction Reflexes and cahn duing Caesarean birth by Epidural with Midazolam and Ketamine

目的对比观察剖腹产选用连续硬膜外麻醉时，辅助麻醉用药镇静及对牵拉反应抑制效果。方法选择行剖腹产手术产妇60例在硬膜外麻醉效果满意后，随机分两组各30例。Ⅰ组：哌替啶50mg，异丙嗪25mg单次静注。Ⅱ组：氯胺酮28．5mg，咪达唑仑1．42mg单次静注。分组记录用药前，1min，5min，15min及术毕产妇SpO2、RR、HR、MAP值；记录手术时间、术毕苏醒例数、术中恶心躁动例数；记录术毕产妇OAA／S评分；记录新生儿娩出时Apger评分。结果两组术中镇静、抑制牵拉反应效果均满意。两组RR、BP、HR、SpO2均平稳；术毕两组OAA／S评分均为4-5分；新生儿Apger评分均正常。结论两组方法效果确切，对产妇和新生儿安全。

Objective To evaluate the efficacy and side-effect of midazolam-ketamine or pethidine-promethazine in the treatment of traction reflexes and calm at caesarean birth during epidural anesthesia. Methods In a randomized study, 60 ASA Ⅰ-Ⅱ lying-in woman epidural anesthesia were allocated randomly to receiving intravenous pethidine 50mg and promethazine 25mg （group Ⅰ, n = 30） or midazolam 28.5mg and ketamine 1.42mg （group Ⅱ, n = 30）. the traction reflexs was observed and calm afther intravenous drugs. Results The same efficacy among two group were to cure traction reflexes and calm, The differences among two groups in RR, BP, HR, SpO2 were insignifcnat at all sampling points. While operation be over, all lying-in woman had clearness. All neonates Apger rating were normal. Conclusion The effect of two means is effective. The lying-in woman and the neonate are safe.