小剂量氯胺酮超前镇痛在剖宫产手术中的应用价值

Application Value of Low-dose Ketamine Preemptive Analgesia in Cesarean Section

目的探讨小剂量氯胺酮超前镇痛在剖宫产手术中的应用价值。方法选取2016年12月至2018年6月于江西省彭泽县妇幼保健院择期行剖宫产手术分娩的孕妇90例作为研究对象,按随机数字表法分为两组,各45例。两组均行硬膜外麻醉,切皮前1 min,试验组行小剂量氯胺酮超前镇痛,对照组静脉注射等剂量0.9%氯化钠注射液。比较两组血流动力学变化、术后疼痛程度及不良反应发生情况。结果试验组胎儿娩出时心率(HR)明显低于对照组,差异有统计学意义(P<0.05);试验组与对照组平均动脉压(MAP)、脉搏血氧饱和度(Sp O2)与麻醉前比较无明显波动,差异无统计学意义(P>0.05);试验组术后4 h、12 h、24 h时视觉模拟评分法(VAS)评分均低于对照组,差异有统计学意义(P<0.05);两组术后各出现1例恶心呕吐,均未发生血压下降、呼吸抑制、皮肤瘙痒等其他不良反应。结论剖宫产手术中使用小剂量氯胺酮超前镇痛可有效维持产妇术中血流动力学稳定,减轻术后疼痛程度,安全性较高。

Objective To explore the application value of preemptive analgesia with low dose ketamine in cesarean section. Methods A total of 90 pregnant women who underwent cesarean section delivery in the Pengze County Maternal and Child Health Hospital of Jiangxi Province from December 2016 to June 2018 were selected as the study objective. They were divided into 2 groups according to the random number table, with 45 cases in each group. Epidural anesthesia was performed in both groups. One minute before the incision, the experimental group received a small dose of ketamine preemptive analgesia and the control group received an equal dose of 0.9% sodium chloride injection intravenously. Hemodynamic changes, postoperative pain levels, and adverse events were compared between the 2 groups. Results The heart rate(HR) of the experimental group was significantly lower than that of the control group, when the baby is delivered(P<0.05)..There was no significant fluctuation in mean arterial pressure(MAP) and pulse oximetry(SpO2) between the experimental group and the control group before anesthesia. The visual analogue scale(VAS) scores of the experimental group, 4 h, 12 h and 24 h after operation was lower than that of the control group(P<0.05);1 case of nausea and vomiting occurred in both groups after operation. There were no other adverse reactions such as blood pressure drop, respiratory depression, and itchy skin etc.. Conclusion The use of low-dose ketamine in cesarean section for advanced analgesia can effectively maintain hemodynamic stability during surgery, reduce postoperative pain, and has higher safety.