小剂量氯胺酮预先静脉注射对蛛网膜下隙与硬膜外腔联合阻滞麻醉下剖宫产手术寒战的防治

Prevention of pretreatment with low-dose ketamine on shivering during cesarean section under subarachnoid space and epidural anesthesia

目的 探讨小剂量氯胺酮预先静脉注射对蛛网膜下隙与硬膜外腔联合阻滞麻醉下剖宫产手术患者寒战预防的有效性和安全性.方法 90例拟在蛛网膜下隙与硬膜外腔联合阻滞麻醉下行剖宫产手术的患者,按随机数字表法分为3组：对照组（30例）、低剂量氯胺酮组（30例）、高剂量氯胺酮组（30例）,手术消毒前对照组经静脉注入3 ml 0.9％氯化钠,低剂量氯胺酮组经静脉注入0.25 mg/kg（3 ml）氯胺酮,高剂量氯胺酮组经静脉注入0.50 mg/kg（3 ml）氯胺酮.分别记录麻醉前、麻醉后15 min、麻醉后30 min、术后1h的寒战发生率及不良事件发生情况.结果 对照组麻醉后15 min、30 min及术后1h平均动脉压（MAP）[（62±10）、（58±8）、（61±11） mm Hg（1 mm Hg=0.133 kPa）]明显低于高剂量氯胺酮组[（78±12）、（82±8）、（76±11） mm Hg]和低剂量氯胺酮组[（72±10）、（76±6）、（80±7）mm Hg],差异有统计学意义（P＜0.05）.高剂量氯胺酮组和低剂量氯胺酮组无一例需要治疗的寒战发生.低剂量氯胺酮组幻觉和眼球震颤的发生率[0、6.7％（2/30）]低于高剂量氯胺酮组[20.0％（6/30）、50.0％ （15/30）],差异有统计学意义（P＜0.05）.结论 预防性静脉注射小剂量氯胺酮（0.25 mg/kg）对蛛网膜下隙与硬膜外腔联合阻滞麻醉下剖宫产手术寒战的发生具有很好的防治效果.

Objective To explore the efficacy and safety of low-dose ketamine for prevention of shivering during cesarean section under subarachnoid space and epidural anesthesia.Methods Ninety pregnant women who scheduled cesarean delivery under subarachnoid space and epidural anesthesia were randomized divided into three groups：control group （30 patients） low-dose ketamine group （30 patients） and high-dose ketamine group （30 patients）.0.9％ sodium chloride,0.25 mg/kg（3 ml）,and 0.50 mg/kg （3 ml） ketamine were given in three groups before operation.The incidence of shivering and adverse effect were recorded respectively before anesthesia,after anesthesia 15 min and 30 min and after operation 1 h.Results The level of mean arterial pressure （MAP） in control group after anesthesia 15 main and 30 min and after operation 1 h[（62 ± 10）,（58 ± 8）,（61 ± 11） mm Hg（1 mm Hg =0.133 kPa）] were significantly lower than those in high-dose ketamine group [（78 ± 12）,（82 ± 8）,（76 ± 11）mm Hg] and low-dose ketamine group [（72 ± 10）,（76 ± 6）,（80 ± 7） mm Hg],there was significant difference （P ＜ 0.05）.There was no shivering need treat in low-dose ketamine group and high-dose ketamine group.The rate of hallucinations and nystagmus in low-dose ketamine group [0,6.7％ （2/30）] was significantly lower than that in high-dose ketamine group [20.0％ （6/30）,50.0％ （15/30）],there was significant difference （P ＜ 0.05）.Conclusion The pretreatment with low-dose ketamine on shivering during cesarean section under subarachnoid space and epidural anesthesia has better preventive effectiveness,0.25 mg/kg of ketamine is more effective than 0.50mg/kg.