小剂量氯胺酮在健忘镇痛麻醉辅助局部麻醉剖宫产中的应用

Application of Low-Dose Ketamine during the Local Anesthesia in Cesarean Section Assisted by Analgestic and Amnestic Anesthesia

目的观察小剂量氯胺酮在健忘镇痛麻醉辅助局部麻醉(局麻)剖宫产中的应用。方法选择1200例剖宫产的孕妇,随机分为单纯局麻组(L组)、氟芬强化局麻组(F组)和健忘镇痛麻醉组(J组),每组400例。L组单纯局麻;F组局麻术中辅以氟哌利多5.00mg,芬太尼0.15mg;J组在F组基础上辅以氯胺酮,观察各组患者麻醉诱导至胎儿娩出时间;新生儿1、5minApgar评分;手术中血压相对于基础值的波动情况;手术中及手术后出血情况及麻醉满意度。结果 J组与L组和F组比较,胎儿娩出时间无显著差别;Apgar评分提高;手术中孕妇血压波动不明显;手术中及手术后出血量无明显增加,麻醉满意度明显提高。结论由小剂量氯胺酮辅助实施的健忘镇痛麻醉在局麻剖宫产中优于单纯局麻和氟芬强化局麻,在剖宫产中尤其急诊剖宫产中值得推广。

Objective To observe the application of low-dose ketamine during the local anesthesia in cesarean section assisted by analgestic and amnestic anesthesia.Methods A total of 1200 cases who need cesarean section were randomly divided into 3 groups（400 cases in each group）：simple local anesthesia group（group L）,droperidol-fentanyl strengthen local anesthesia group（group F）and analgestic and amnestic anesthesia group（group J）.Group L was only local anesthesia.Group F was local anesthesia supplemented by droperidol 5.00 mg,fentanyl 0.15 mg.Group J was supplemented with ketamine on the basis of group F.Then the time from anesthesia to the fetus delivery,Neonatal Apgar score of one and five minutes,the blood pressure fluctuations,amount of bleeding in or after surgery and the satisfaction of anesthesia were all observed.Results Compared with group L and F,the delivery time was no significant difference,Apgar score increased,blood pressure fluctuations in pregnant women was not obviously varied,amount of bleeding in or after surgery had no significantly increase,and the satisfaction of anesthesia improved markedly all in group J.Conclusions The analgestic and amnestic anesthesia assisted by low-dose ketamine,in cesarean section,is better than local anesthesia and strengthen local anesthesia by droperidol-fentanyl,which is worthy to be popularized,especially in emergency caesarean section.