艾司氯胺酮用于剖宫产术中镇静对新生儿的影响  

Effects of Esketamine Used for Sedation During Caesarean Section on Neonates

作　　者：林常森[1] 王承海[2] 赵鲁夕 唐晓莉[2] 张文红 张杰[2] 李文广 魏福江[2] LIN Changsen;WANG Chenghai;ZHAO Luxi;TANG Xiaoli;ZHANG Wenhong;ZHANG Jie;LI Wenguang;WEI Fujiang(Department of Anesthesiology,Affiliated Hospital of Shandong University of Traditional Chinese Medicine,Ji'nan Shandong 250014,China;Department of Anesthesia,Yantaishan Hospital,Yantai City,Yantai Shandong 264008,China;The Teaching and Research Section of Surgery,First Clinical Medical College,Shandong University of Traditional Chinese Medicine,Ji'nan Shandong 250014,China)

机构地区：[1]山东中医药大学附属医院麻醉科,山东济南250014 [2]烟台市烟台山医院麻醉科,山东烟台264008 [3]山东中医药大学第一临床医学院外科教研室,山东济南250014

出　　处：《中国卫生标准管理》2024年第4期131-135,共5页China Health Standard Management

基　　金：烟台市科技计划项目(2022YD058)。

摘　　要：目的 探讨艾司氯胺酮用于剖宫产术中镇静对新生儿的影响。方法 选择2022年1月—2023年12月于山东中医药大学附属医院和烟台市烟台山医院就诊的60例行择期子宫下段剖宫产术产妇,随机分为艾司氯胺酮组(K组,30例)和对照组(C组,30例)。蛛网膜下腔麻醉平面固定后,K组静脉注射艾司氯胺酮0.2 mg/kg,C组静脉注射等容积生理盐水。比较2组产妇牵拉不适感和桡动脉血气分析;胎儿剖出时采血,查脐动脉、脐静脉血气分析。结果 K组T_(2)、T_(3)、T_(4)、T_(5)、T_(6)时HR和MAP与C组比较,差异有统计学意义(P <0.05)。K组与C组切皮开始至胎儿剖出时间分别为(10.10±1.37)min和(15.40±1.77)min(P <0.05)。出胎时C组产妇牵拉不适感发生率高于K组(P <0.05)。K组脐动脉和脐静脉氧分压(partial pressure of oxygen,PO_(2))高于C组(P <0.05),乳酸(blood lactic acid,Lac)低于C组(P <0.05),血红蛋白饱和度(oxygen saturation of hemoglobin,SO_(2))高于C组(P<0.05)。所有产妇及新生儿均无严重不良反应发生。结论 艾司氯胺酮可安全用于剖宫产术中镇静,对新生儿Apgar评分及产妇和新生儿血气分析无明显不良影响。Objective To explore the effect of esketamine used for sedation during cesarean section on newborns.Methods A total of 60 women who underwent elective lower uterine cesarean section in Affiliated Hospital of Shandong University of Traditional Chinese Medicine and Yantaishan Hospital,Yantai City from January 2022 to December 2023 were selected and randomly divided into esketamine group(group K,30 cases) and control group(group C,30 cases).After the subarachnoid anesthesia plane was fixed,the group K received intravenous injection of esketamine 0.2 mg/kg,and the group C received intravenous injection saline of equal volume.The traction discomfort and radial blood gas analysis were compared between the two groups.Blood was collected during fetal dissection,and blood gas analysis was performed on umbilical artery and umbilical vein.Results There were significant differences in HR and MAP between group K and group C at T_2,T_3,T_4,T_(5) and T6(P < 0.05).The time from the start of skin incision to fetal dissection in group K and group C was(10.10±1.37) min and(15.40±1.77) min(P < 0.05).The incidence of traction discomfort in group C during pregnancy was higher than that in group K(P <0.05).The partial pressure of oxygen(PO_2) in umbilical artery and umbilical vein in group K was higher than that in group C(P < 0.05),and the blood lactic acid(Lac) was lower than that in group C(P <0.05).The oxygen saturation of hemoglobin(SO_2) was higher than that of C group(P < 0.05).No serious adverse reactions occurred in all pregnant women and newborns.Conclusion Esketamine can be safely used for sedation during cesarean section,and has no significant adverse effects on neonatal Apgar score and maternal and neonatal blood gas analysis.

关 键 词：艾司氯胺酮 镇静 产科 血气分析 不良反应 RAMSAY镇静评分 

分 类 号：R614[医药卫生—麻醉学]