小剂量氯胺酮复合瑞芬太尼用于剖宫产全麻的疗效观察

[目的]探讨小剂量氯胺酮复合瑞芬太尼用于剖宫产全麻对产妇和新生儿的安全性和有效性并与瑞芬太尼用于刮宫产全麻对产妇和新生儿的影响进行比较。[方法]选择ASAI～Ⅱ级，孕37～39周择期剖宫产产妇60例，随机分为两组：Ⅰ组（氯胺酮0．5mg／kg，瑞芬太尼0．5μg／kg）和Ⅱ组（瑞芬太尼1μg／kg），每组各30例。记录两组产妇诱导前（Tn）、气管插管前（T1）、插管后即刻（T2）、拔管后即刻（T3）的血压、心率；两组新生儿1、5min的Apgar评分及新生儿娩出时脐动脉血pH、PCO2、PO2；术后随访两组产妇术中知晓发生情况。[结果]（1）Ⅰ组产妇诱导后各时点MAP和HR与诱导前相比差异无统计学意义（P〉0．05），Ⅱ组与诱导前相比有显著差异（P〈0．05），两组同时点相比有显著差异（P〈0．05）。（2）两组产妇均无术中知晓。（3）两组新生儿的Apgar评分及娩出时脐动脉血pH、PCO2、PO2相比差异无统计学意义（P〉0．05）。[结论]小剂量氯胺酮复合瑞芬太尼全麻对剖宫产产妇及新生儿安全有效，且较瑞芬太尼全麻能更好地维持产妇的血流动力学稳定。

Effects of small-dose ketamine combined with remifentanil in cesarean section

[Objective]To assess the analgesic safety and efficacy of combined small-dose ketamine and remifentanil general anesthe- sia for cesarean delivery on puerpera and newborn, and compare with remifentanil simply. [ Methods] 60 puerperas undergoing elective cesarean section under general anesthesia, ASA grade Ⅰ or Ⅱ, 37-39 weeks pregnancy, were randomly divided into two groups：group Ⅰ （ketamine 0.5 mg/kg, remifentanil 0.5 μg/kg）and group Ⅱ （remifentanil 1 μg/kg）, 30 cases in each group. MAP and HR of the two groups were recorded before induction（T0）, before tracheal intubation（TL）, after intubation（T2） and after extubation（T3）, Neonatal 1, 5 rain Apgar score and the umbilical artery blood gas analysis （pH, PCO2, PO2） were also recorded. Intraoperative awareness was noted the next day. [ Results] （1）There were no significant differences in MAP and HR at each time point after induction in group Ⅰ （P 〉 0.05）while significant differences were detected in group Ⅱ （P 〈 0.05）. Between two groups, the differences were significant at various time points after induction（P 〈 0.05）. （2）The follow-up showed that no intraoperative awareness occurred in both groups. （3）There were no signifi- cant differences in Apgar score and the umbilical artery blood gas analysis（pH, PCO2, PO2） between two groups（P 〉 0.05）. [Conclusion ] Combined small-dose ketamine and remifentanil general anesthesia for cesarean section is safe and effective for puerpera and newborn, and can better maintain she hemodynamic stability of puerpera than remifentanil simply.