氯胺酮在高危产妇剖宫产术全麻中对新生儿呼吸的影响  

Effect of ketamine on neonatal respiration in high-risk pregnant women with cesarean section and general anesthesia

作　　者：石春生[1] 王允锋[2] 邵丽娜[1] 王林[1] 

机构地区：[1]首都医科大学密云教学医院麻醉科,北京101500 [2]首都医科大学密云教学医院妇产科,北京101500

出　　处：《临床药物治疗杂志》2015年第3期41-44,共4页Clinical Medication Journal

摘　　要：目的：研究氯胺酮在合并有并发症产妇的剖宫产术全麻中应用的安全性和可行性。方法：选择ASA分级Ⅱ-Ⅲ级的产妇40例,随机分为氯胺酮全麻组（Q组）和椎管内麻醉组（Z组）。Q组方案：静注氯胺酮1mg·kg^-1、司可林100 mg,气道表面麻醉后行气管插管,手术开始至胎儿娩出前一般无需追加上述药物,若追加氯胺酮其总量不超过1.5 mg·kg^-1、司可林总量不超过200 mg,胎儿娩出后立即抽取胎儿脐带血行血气分析并对胎儿进行1min和5 min Apgar评分。观察产妇入室至离室各时间点的血压、心率、脉率血氧饱和度及产妇入室至手术开始所需的时间等指标。并记录两组新生儿出生后3-5 d的新生儿神经行为评分（NBNA）。结果 ：在两组血气分析数值中Q组氧分压和血氧饱和度两项值均高于Z组,两组比较有统计学意义（P〈0.05）,其他指标差异无统计学意义（P〉0.05）,新生儿1 min和5 min Apgar评分两组差异无统计学意义（P〉0.05）。产妇的血压、心率两组间在个别时间点比较有统计学意义（P〈0.05）,脉率血氧饱和度两组比较无统计学意义（P〉0.05）,产妇入室至手术开始所需的时间Q组明显短于Z组,两组比较有统计学意义（P〈0.05）。两组新生儿NBNA评分差异无统计学意义（P〉0.05）。结论：氯胺酮可以安全地用于剖宫产术全麻中,尤其适用于危重或禁用椎管内麻醉的产妇。Objective： To study the safety and feasibility of the ketamine in general anesthesia and cesarean section with maternal complications. Methods：40 maternal patients with ASA classification Ⅱ-Ⅲ levels were randomly divided into ketamine anesthesia group （Q group ） and spinal anesthesia group （Z group）. Q group strategy： undergoing endotracheal intubation after intravenous administration of ketamine lmg.kga and succinylcholine 100 mg and airway surface anesthesia, from the starting of surgery to delivering the baby these drugs were generally not need to be appended. The total amount of ketamine and succinylcholine did not exceed 1.5 mg-kg^-1 and 200 mg if these drugs were added.Umbilical cord blood was drawn immediately after delivery of the fetus and blood gas analysis and Apgar score for 1 minute and 5 minute were recorded. The blood pressure, heart rate and oxygen saturation of pulse rate of maternal and the time period between entering operating room and starting of operation were observed from entering operating room to leaving operating room. Neonatal nerve behavior scores were recorded after birth from 3 to 5 days in the two groups. Results：In both groups, the value of blood gas analysis of oxygen partial pressure and oxygen saturation in Q group was higher than those in Z group. The results between two groups had statistically significant difference （P〈0.05）.The other values had no statistically significant difference （P〉0.05）. Apgar score of 1 minute and 5 minute between the two groups had no statistically significant difference （P〉0.05）. Maternal blood pressure, heart rate between the two groups at individual time points had statistically significant difference （P〈0.05）. Oxygen saturation of pulse rate between the two groups had no statistically significant difference （P〉0.05）. The time observed from entering operating room to starting operation in Q group was shorter than that in Z group. The results between two groups had statistically significant differe

关 键 词：氯胺酮 高危产妇 剖宫产 全麻 

分 类 号：R971.2[医药卫生—药品]