小剂量氯胺酮和丙泊酚复合硬膜外麻醉在剖宫产手术中的应用

Application of low dose of ketamine and propofol combined with epidural anesthesia in cesarean section in pregnant women

目的:观察小剂量氯胺酮和丙泊酚复合硬膜外麻醉在剖宫产手术中的应用。方法:46例A SAⅠ-Ⅱ级拟行剖宫产孕妇,术前各项检查及胎儿均无异常,将两组产妇随机分为单纯硬膜外麻醉组(Ⅰ组)和小剂量氯胺酮与丙泊酚复合硬膜外麻醉组(Ⅱ组),每组23例。Ⅰ组孕妇单纯硬膜外麻醉,术中未用辅助药,Ⅱ组孕妇在硬膜外麻醉完善后于切皮前给予氯胺酮0.5m g/kg和丙泊酚1m g/kg,随后以氯胺酮0.5m g/kg.h和丙泊酚1m g/kg.h速度泵入,观察两组产妇的BP、HR、SpO2的变化及术中表现,并记录两组新生儿1m in和5m in的A pgar评分。结果:Ⅰ组产妇在分离腹膜和取胎儿时的BP明显高于Ⅱ组,也高于手术开始前(P<0.01),HR在Ⅰ组产妇中也明显高于手术开始前和Ⅱ组(P<0.01),而在Ⅱ组产妇中的BP、HR则较稳定,与手术前相比变化较小(P>0.05)。Ⅱ组产妇在手术中的表现明显优于Ⅰ组(P<0.01)。两组产妇的SpO2及两组新生儿的1m in和5m in的A pgar评分无统计学差异(P>0.05)。结论:在剖宫产手术中,应用小剂量氯胺酮和丙泊酚复合硬膜外麻醉可以减少产妇术中的紧张恐惧及应激反应,使血流动力学平稳,并且能使产妇安静舒适。

Objective： To observe the effects of low--dose of ketamine and propofol combined with epidural anesthesia in cesarean section in pregnant women. Methods：forty-six PartUrients （ASA grade Ⅰ-- Ⅱ）were randomly allocated into epidural anesthesia group（Group Ⅰ,n=23）and low--dose of ketamine and combined epidural anesthesia group（Group Ⅱ,n=23）. The Parturients in Group Ⅰ only receieved epidural block,and those in Group Ⅱ not only received epidural block but also were given ketamine 0. 5mg/kg and propofol 1mg/kg before skin incision by intravenous injection and after that;ketamine 1mg ·kg^-1·h^-1 with propofol 4mg· kg^-1·h^-1was continuously pumped into vein. In the twogroups the parturients＇ BP, HR, SpO2, the reaction in operation and the 1min and 5min Apgar scores of newborn were recorded. Results：In Group Ⅰ,BP was significantly higher at the time of separating peritoneum and getting fetuses than that at preoperation and than that of Group Ⅱ （P 〈2 0. 01 ）. The index of HR in Group Ⅰ was significantly higher than that in Group Ⅱ （P 〈 0. 05） ,and however, BP and HR in Group Ⅱ were stable. In operation,the reaction in Group Ⅱ was better than that in Group Ⅰ （P 〈 0.05） . The newborn＇s 1min and 5min Apgar scores in the two groups showed no difference （P〉 0.05） . Conclusion. Low -- dose of ketamine and propofoi combined with epidural anesthesia in the operation of ceasarean section can decrease stress,stabilize hemodynamies and make parturients comfortable.