阈下剂量氯胺酮用于剖宫产术的量效观察

The observation of concentration-response with Thresholddos Ketamine using in cesarean section

目的观察硬膜外剖宫产手术辅用氯胺酮的方法、剂量、效果。方法硬膜外麻醉效果欠佳的48例产妇随机分为两组：A组24例在胎儿娩出前2rain静脉点滴咪唑安定0．02mg／kg，娩胎儿时静脉滴入氯胺酮0．4mg／kg，以后视需要追加氯胺酮每次0．4mg／kg；B组24例静脉用药为氯胺酮0．8mg／kg，娩胎儿后追加氯胺酮每次0．8mg／kg，所有辅助用药都控制在胎儿娩出前2min。结果所有产妇都安全有效完成手术，用药后生命体征平稳，Apgar评分满意，镇痛效果好。A组复合运用了咪唑安定，相对综合指标更优：肌松更好，躁动少，对妊娠高血压综合征控制更好，氯胺酮有效剂量是0．4mg／kg。结论剖宫产硬膜外麻醉效果欠佳时，辅用阈下剂量氯胺酮（0．4～0．8）mg／kg，均能保证产妇、胎儿安全有效，以0．4mg／kg辅以0．02mg／kg咪唑安定应用更佳，可以在满足手术要求的同时，减少副反应，对妊娠高血压产妇也能使用。

Objective To investigate the methods,the dose and the effect of ketamine with epidural anesthesia using in ce- sarean section. Methods All 48 pregnant women with Epidural anesthesia were randomly divided into two groups, group A of 24 cases use Midazolam 0.02 mg/kg in the first two minutes fetal childbirth, ketamine 0.4 mg/kg, iv, add the ketamine every time 0.4 mg/kg when dropping into theas needed; Group B 24 cases for intravenous administration ketamine 0.8 mg/ kg, Mian fetal additional after ketamine every time 0.8 mg/kg, all drugs are auxiliary control in the first two minutes fetal newborn baby. Results All cases were safe and effective when the drug was finished, analgesic effect was good. Group A compound used Midazolam, the relatively comprehensive index is more superior： muscle loose better, less restless, on preg- nancy hypertension syndrome better control, ketamine an effective dose is 0.4 mg/kg. Conclusion Using in ketamine 0.4- 0.8 mg/kg of Cesarean section epidural anesthesia can make sure the puerpera fetus, safe and effective,but 0.4mg/kg, ke- tamine, iv, complementary with 0.02 mg/kg Midazolam application, can be in better meet the demands of the surgery at the same time, reduce the side effects in pregnant women, on pregnancy hypertension syndrome can also be used.