氯胺酮用于躁狂型精神分裂症产妇行剖宫产麻醉的可行性

Feasibility study report of Ketamine for caesarean operation of manic type schizophrenic parturient

目的：讨论躁狂型精神分裂症产妇行剖宫产的麻醉方法，使用氯胺酮静脉注射的可行性。方法：8例狂躁型精神分裂症育龄产妇，强行固定患者，迅速开放静脉，面罩给氧，给予氯胺酮0．5～1mg／kg静脉注射，患者很快进入麻醉状态。手术切口局麻后。在胎儿未取出前患者麻醉转浅，可再给氯胺酮0．5～1mg／kg静脉注射。胎儿取出后经静脉注射安定0．2mg／kg、哌替啶2mg／kg、氟哌利多0．1mg／kg维持麻醉。手术时问为（45．50＋5．25）min。术后给予氟哌利多0．1mg／kg及氢溴酸东莨菪碱0．3mg肌肉注射，2次／d，连用1周。结果：手术过程顺利，根据Apgar评分胎儿均为8～10分，无1例出现呼吸抑制现象。术后给予抗精神分裂症治疗，8例病例中无1例出现精神症状加重现象。结论：氯胺酮静脉麻醉在胎儿取出后联合氟哌利多用于躁狂型精神分裂症产妇行剖宫产是可行的。

Objective： To study the anesthesia method for caesarean operation of manic type schizophrenic parturient and the possibility of Ketaminum intravenous anesthesia for caesarean operation. Methods： Eight manic type schizophrenic maturity women were fixed violently, openning venous pass and offering oxygen with mask, than inject Ketamine（0. 5～1mg/kg）intravenously. Before fetal birth Ketamine （0. 5～1mg/kg was injected） intravenously again when anesthasia became shallow during operation. After fetal birth diazepam （0. 2mg/kg）, pethidine （2mg/kg）, droperidol（0.1mg/kg） was injected. Intravenously maintained anesthesia. The operation time was 45. 504-5.25min. After the operation the patients were given droperidol （0. 1mg/kg） and scopolamine hydrohromide （0. 3mg） by intramuscular injection twice everyday for a week. Results： The operative course was smooth, and the Apgar scores was 94-1. There was no respiratory inhibition in those eight patients. After the operation Antipsychotic medication therapy was given to those 8 patient, and no one showed aggravating of psychotic symptoms. Conclusion：It is feasible to do intravenous general anesthesia after fetal birth with Ketatnine and droperidol on caesarean operation of manic type schizophrenic parturient.