小剂量氯胺酮和曲马多预防剖宫产术蛛网膜下腔麻醉后寒战效果分析  

Low dose of ketamine and tramadol in preventing shivering after spinal anaesthesia in cesarean section

作　　者：陈岱莉[1] 齐晓非[1] 庄仁坤[2] 黄晓雷[1] 李元涛[1] 

机构地区：[1]广东省深圳市妇幼保健院麻醉科,518028 [2]广东省深圳市妇幼保健院超声科,518028

出　　处：《中国医药》2015年第6期869-871,共3页China Medicine

摘　　要：目的 探讨小剂量氯胺酮和曲马多预防剖宫产术蛛网膜下腔麻醉后寒战的效果.方法 纳入择期接受剖宫产术的产妇120例,按随机数字表法将产妇分为氯胺酮组（40例）、曲马多组（40例）和对照组（40例）.胎儿娩出后,氯胺酮组静脉注射氯胺酮0.25 mg/kg,曲马多组静脉注射曲马多0.25 mg/kg,对照组给予相同体积0.9％氯化钠注射液.于给药后15、30和45 min观察寒战程度、测量鼓膜温度,观察不良反应发生情况.结果 给药后各时点产妇寒战程度氯胺酮组（15 min：无寒战;30 min：1例1级;45 min：1例1级）和曲马多组（15 min：1例1级;30 min：1例1级、1例2级;45 min：2例1级、1例2级）均低于对照组（15 min：8例1级、7例2级、5例3级;30 min：9例1级、8例2级、5例3级;45 min：10例1级、8例2级）,差异均有统计学意义（均P ＜0.05）,氯胺酮组与曲马多组比较差异无统计学意义（P＞0.05）.3组产妇给药后15、30、45 min鼓膜温度与基础鼓膜温度比较均降低,其中氯胺酮组[（36.06 ±0.14）、（36.11 ±0.13）、（36.26±0.12）℃]明显高于于对照组[（35.82±0.22）、（35.94 ±0.18）、（36.07±0.19）℃]和曲马多组[（35.87±0.20）、（35.95±0.16）、（36.07±0.12）℃],差异均有统计学意义（均P＜0.05）.给药后各时间点氯胺酮组和曲马多组产妇均出现不同程度镇静,对照组产妇均无镇静发生.对照组1例出现恶心,氯胺酮组1例出现恶心、1例发生呕吐,曲马多组2例出现恶心、2例发生呕吐,3组均未发生幻觉和眼球震颤.结论 预防性给予小剂量氯胺酮和曲马多可明显减少剖宫产术蛛网膜下腔麻醉后寒战的发生,且没有明显的不良反应.Objective To compare the efficacy of low dose of ketamine and tramadol in prevention of shivering after spinal anaesthesia in cesarean section.Methods Totally 120 partients receiving selective cesarean section were enrolled and randomly divided into ketamine group （40 cases） injected with ketamine （0.25 mg/kg） intravenously,tramadol group （40 cases） injected with tramadol （0.25 mg/kg） intravenously,and control group （40 cases） injected with 0.9% sodium chloride injection.The shivering degree,tympanic temperature and side effects such as sedation,nausea and vomiting,hallucinations and nystagmus were observed and recorded 15,30 and 45 min after administration.Results At each time point,shivering degree in ketamine group （15 min：0 of Shivering,30 min：1 of grade 1,45 min：1 of grade 1） and tramadol group （15 min：1 of grade 1,30 min：1 of grade 1,1 of grade 2,45 min：2 of grade 1,1 of grade 2） was all significantly lower than that in control group （15 min：8 of grade 1,7 of grade 2,5 of grade 3,30 min：9 of grade 1,8 of grade 2,5 of grade 3,45 min：10 of grade 1,8 of grade 2） （all P 〈 0.05）,while there were no significant differences between ketamine and tramadol group （P 〉 0.05）.The tympanic temperature of three groups all decreased compared with basic tympanic temperature,and the temperature in ketamine group [15 min：（36.06 ± 0.14）℃,30 min：（36.11 ±0.13）℃,45 min：（36.26 ±0.12）℃] was significantly higher than that in control group [15 min：（35.82 ±0.22）℃,30 min：（35.94±0.18）℃,45 min：（36.07±0.19）℃] and tramadol group [15 min：（35.87±0.20）℃,30 min：（35.95 ± 0.16） ℃,45 min：（36.07 ± 0.12） ℃] with statistical differences （all P 〈 0.05）.Sedation occurred in both ketamine group and tramadol group,but it did not occur in control group.Nausea occurred in 1 case in control group,1 case in ketamine group and 2 case in tramadol group;vomiting occurred in 1 case in ketamine group and 2 case in t

关 键 词：剖宫产术 麻醉 脊柱 寒战 氯胺酮 曲马多 

分 类 号：R614[医药卫生—麻醉学]