小剂量艾司氯胺酮防治剖宫产术中寒战及牵拉反应的有效性与安全性分析  

Efficacy and safety analysis of low dose esketamine in the prevention and treatment of shivering and traction reaction during cesarean section

作　　者：杨铎 张隆盛[1] 黄熙扬 叶淑君 孙琪琪 陈哲璇 张欢楷[1] 黄志良[1] YANG Duo;ZHANG Longsheng;HUANG Xiyang;YE Shujun;SUN Qiqi;CHEN Zhexuan;ZHANG Huankai;HUANG Zhiliang(Department of Anesthesiology,Jieyang People’s Hospital,Jieyang 522000,China)

机构地区：[1]揭阳市人民医院,广东揭阳522000

出　　处：《现代医院》2023年第10期1600-1604,共5页Modern Hospitals

基　　金：广东省医学科学技术研究基金(B2022294)。

摘　　要：目的 探讨小剂量艾司氯胺酮防治剖宫产术中寒战及牵拉反应的有效性和安全性。方法 选择腰硬联合麻醉下行剖宫产术的单胎足月产妇90例,年龄20~40岁,ASA分级Ⅱ级,体重55~85 kg。将患者随机分为对照组(C组)、0.15 mg/kg艾司氯胺酮组(K15组)和0.3 mg/kg艾司氯胺酮组(K30组),每组30例。三组产妇均采用腰硬联合麻醉,麻醉平面控制于T_(6)~T_(8)。手术开始前1 min,K15组和K30组患者分别静脉注射艾司氯胺酮0.15 mg/kg和0.30 mg/kg,C组注射等容量生理盐水。记录入室5 min后(t_(0))、试验药物注射前即刻(t_(1))、试验药物注射后10 min(t_(2))、20 min(t_(3))、30 min(t_(4))及术毕(t_(5))寒战发生的情况。记录胎儿娩出时、清理腹腔时牵拉反应发生的情况。记录新生儿出生后1 min和5 min的Apgar评分及出生后3 d的行为神经测评量表(NBNA)。记录产妇恶心呕吐、呼吸抑制、头晕、眼球震颤、精神神经症状等不良反应发生的情况。结果 最终完成研究85例。在t_(2)、t_(3)、t_(4)、t_(5)时,K15组和K30组的寒战发生率低于C组(P<0.05)。在胎儿娩出时K15组和K30组的牵拉反应程度低于C组,而在清理腹腔时K30组的牵拉反应程度低于C组和K15组(P<0.05)。三组新生儿出生后1 min和5 min的Apgar评分及产后3d NBNA评分的差异均无统计学意义(P>0.05)。三组产妇术中及术后不良反应发生率的差异无统计学意义(P>0.05)。结论 在腰硬联合麻醉下行剖宫产时,术前使用0.3 mg/kg艾司氯胺酮能安全、有效地防治术中寒战和牵拉反应。Objective To investigate the efficacy and safety of low dose esketamine in the prevention and treatment of shivering and traction reaction during cesarean section.Methods A total of 90 full-term singleton parturients undergoing cesarean section under combined spinal-epidural anesthesia,aged 20~40,ASA grade II,weight 55~85 kg,were included into this study.The patients were randomly divided into three groups:the control group(group C),0.15 mg/kg esketamine group(group K15)and 0.3 mg/kg esketamine group(group K30),with 30 cases in each group.The three groups of parturients received combined spinal-epidural anesthesia,and the anesthesia plane was adjusted to the level of T_(6)~T_(8).1 min before operation,patients in groups K15 and K30 were intravenously injected with 0.15 mg/kg and 0.30 mg/kg of esketamine,respectively,and patients in group C were injected with an equal volume of normal saline.The occurrence of shivering was recorded 5 min after entering the operation room(t_(0)),immediately before injection of experimental drug(t_(1)),10 min(t_(2)),20 min(t_(3)),30 min(t_(4))after injection of experimental drug and the end of the operation.The occurrence of the traction reaction was recorded during the delivery of the fetus and during the cleaning of the abdominal cavity.Apgar score 1 min and 5 min after birth and neonatal behavioral neurological assessment scale 3d after birth were recorded.The occurrence of adverse reactions including nausea and vomiting,respiratory depression,dizziness,nystagmus and psychoneurotic symptoms were recorded.Results Finally,85 cases were completed.At t_(2),t_(3),t_(4),and t_(5),the incidence of shivering in groups K15 and K30 was lower than that in group C(P<0.05).The degree of traction reaction in groups K15 and K30 was lower than that in group C during the delivery of the fetus,and the degree of traction reaction in group K30 was lower than that in groups C and K15 during the cleaning of the abdominal cavity.There were no significant differences in Apgar score 1min and 5 min after

关 键 词：艾司氯胺酮 剖宫产 寒战 牵拉反应 

分 类 号：R197[医药卫生—卫生事业管理]