不同剂量的艾司氯胺酮在剖宫产全身麻醉诱导中的应用  

Application of different doses of esketamine in general anesthesia induction of cesarean section

作　　者：李永乐[1] 陈祥楠[1] 方琴[1] 黄微 袁超[1] 杨世辉[1] LI Yong-le;CHEN Xiang-nan;FANG Qin;HUANG Wei;YUAN Chao;YANG Shi-hui(Department of Anesthesiology,Guangdong Women and Children Hospital,Guangzhou GUANGDONG 511400,China)

机构地区：[1]广东省妇幼保健院麻醉科,广东广州511400

出　　处：《中国新药与临床杂志》2023年第2期136-140,共5页Chinese Journal of New Drugs and Clinical Remedies

基　　金：广东省医院药学研究基金(2020XC51)。

摘　　要：目的观察不同剂量艾司氯胺酮对剖宫产全身麻醉诱导中丙泊酚用量的影响,并评估其应用安全性。方法选择拟行剖宫产术的住院产妇60例,随机分为空白对照组(C组)、艾司氯胺酮低剂量组(L组)和高剂量组(H组),每组20例。3组均采用快速静脉诱导,L组、H组分别静脉注射艾司氯胺酮0.25、0.5 mg·kg^(-1),C组给予氯化钠注射液,随后均给予丙泊酚1 mg·kg^(-1)·min^(-1)、瑞芬太尼1μg·kg^(-1)、罗库溴铵0.6 mg·kg^(-1)。于Nacrotrend指数稳定在D1~D2水平时行气管插管,后以丙泊酚和瑞芬太尼静脉泵注维持麻醉,手术剖出婴儿后,静脉注射舒芬太尼0.5μg·kg^(-1)。比较3组产妇麻醉诱导中丙泊酚的用量,麻醉诱导前、气管插管时及胎儿取出时的平均动脉压(MAP)、心率(HR)和Nacrotrend指数,记录每组麻醉诱导时间、胎儿取出时间、手术时间、麻醉复苏时间以及围术期不良反应的发生情况。评估新生儿的Apgar评分,并于胎儿取出时抽取脐带血行血气分析。结果3组胎儿取出时间、手术时间、麻醉复苏时间比较无显著差异(P>0.05),L组和H组丙泊酚麻醉诱导总用量低于C组(P<0.05),H组丙泊酚麻醉诱导剂量低于其他两组(P<0.05),麻醉诱导时间短于其他两组(P<0.05)。与麻醉诱导前比较,3组气管插管时及胎儿取出时MAP和Nacrotrend指数均降低(P<0.05),HR无明显变化(P>0.05)。气管插管时,L组和H组MAP和Nacrotrend指数均高于C组(P<0.05),L组和H组组间比较无显著差异(P>0.05)。3组脐动脉血血气分析指标,新生儿出生3、5 min Apgar评分组间比较均无显著差异(P>0.05),H组1 min Apgar评分高于C组(P<0.05)。H组术中低血压发生率低于C组(P<0.05),心动过缓、头晕和恶心呕吐发生率3组间比较均无显著差异(P>0.05)。结论复合艾司氯胺酮0.5 mg·kg^(-1)可减少全身麻醉剖宫产术中丙泊酚的诱导用量,且较安全。AIM To investigate the effects of esketamine on the dosage of propofol during general anesthesia induction of cesarean section,and to evaluate its safety on mothers and infants.METHODS A total of 60 hospitalized puerpera undergoing cesarean section were selected and randomly divided into control group(group C),esketamine low-dose group(group L)and esketamine high-dose group(group H).All the pregnant women were treated with rapid intravenous induction.Group H was intravenously injected 0.5 mg·kg^(-1) of esketamine,group L was intravenously injected 0.25 mg·kg^(-1) of esketamine,and group C was intravenously injected with sodium chloride injection of the same volume.Then propofol 1 mg·kg^(-1)·min^(-1),remifentanil 1μg·kg^(-1) along with rocuronium 0.6 mg·kg^(-1) were given.Endotracheal intubation was performed when Nacrotrend index was stable at D1-D2,and anesthesia was maintained with intravenous infusion of propofol and remifentanil.After the infant was deliveried,sufentanil 0.5μg·kg^(-1) was injected intravenously.The dosage of propofol,mean arterial pressure(MAP),heart rate(HR)and Nacrotrend index before anesthesia induction,during endotracheal intubation and fetal removal were compared among groups.Duration of anesthesia induction,fetal removal,operation,anesthesia resuscitation and the occurrence of perioperative adverse reactions in each group were recorded.The neonatal Apgar score was evaluated,and umbilical cord blood was extracted for blood gas analysis when the fetus was removed.RESULTS There were no significant differences in duration of fetal removal,operation,and anesthesia resuscitation among three groups(P>0.05).The total consumption propofol for induction of anesthesia in the group L and group H was lower than that in the group C(P<0.05).The induction dose of propofol in the group H was lower than that in the other two groups(P<0.05),and the duration of anesthesia induction was shorter than that in the other two groups(P<0.05).Compared with those before induction of anesthesia,MAP and Nacr

关 键 词：丙泊酚 艾司氯胺酮 剖宫产术 新生儿 麻醉诱导 

分 类 号：R971[医药卫生—药品]