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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 ketamine in general anesthesia of cesarean section with complications. Methods: Forty patients with ASA grade Ⅱ ~ Ⅲ were selected and randomly divided into general anesthetic group (Q group) and spinal anesthesia group (Z group). Q group regimen: intravenous ketamine 1mg · kg-1, Secretary Hill 100 mg, tracheal intubation after airway surface anesthesia, surgery to the fetus before delivery generally do not need to add the above drugs, if the total amount of additional ketamine does not exceed 1.5 kg · kg-1, and the total amount of scoroline did not exceed 200 mg. Blood samples were drawn from the umbilical cord blood immediately after the fetus was delivered and the fetus was subjected to 1 and 5 min Apgar scores. Observation of maternal entry to the point of departure from the room at various time points of blood pressure, heart rate, pulse oxygen saturation and maternal entry to the time required for surgery and other indicators. Neonatal neurobehavioral score (NBNA) was recorded between 3 and 5 days after birth in both groups. Results: The oxygen partial pressure and oxygen saturation in Q group were higher than those in Z group in both groups (P <0.05), while there was no significant difference in other indexes (P > 0.05). Neonatal Apgar score at 1 min and 5 min had no significant difference between the two groups (P> 0.05). The blood pressure and heart rate of maternal group were statistically significant at individual time points (P <0.05), but there was no significant difference between the two groups (P> 0.05) The time Q group was significantly shorter than the Z group, the two groups were statistically significant (P <0.05). Neonatal NBNA score difference was not statistically significant (P> 0.05). Conclusions: Ketamine is safe for use in general anesthesia with cesarean section and is particularly suitable for women who are in critical or non-spinal anesthesia.