氯胺酮和曲马多在剖宫产术中预防寒战的临床观察

目的观察氯胺酮、曲马多在剖宫产术巾预防寒战的效果。方法选择ASAⅠ～Ⅱ级足月产妇60例，随机分为3组：K组（氯胺酮）、T组（曲马多）和N组（生理盐水），n=20。腰硬联合麻醉后，3组分别静注氯胺酮0．5mg·kg^-1，曲马多1mg·kg^-1，生理盐水5ml。监测产妇呼吸、循环的变化，记录新生儿Apgar评分，观察记录产妇有无寒战及其他不良反应发生。结果寒战发生率：K组5％、T组10％、N组40％。K组、T组和N组相比有统计学差异（P〈0．05）。K组和T组相比无统计学差异（P〉0．05）。K组在注射后10rain心率增快，血压升高。镇静评分：K组和T组无统计学差异（P〉0．05）。K组和T组牵托反应较N组明显减少（P〈0．05），但T组恶心、呕吐高于K组（P〈0．05）。结论氯胺酮和曲马多均能有效地预防剖宫产术中寒战的发生，两者的镇静效果及对牵拉反应的抑制也无明显差别。但曲马多较氯胺酮有更高的恶心、呕吐反应发生率。

Clinical Obseration of Ketamine and Tramodol on Preventing Shivering in Caesarean Section

Objective To observe the effects of ketamine and tramodol on preventing shivering in caesarean section. Methods Sixty parturients,ASA ⅠⅡ degree,were chosen and randomly divided into three groups, namely Group K （ketamine） , Group T（tramadol） and Group N （normal saline） , n = 20. After combined spinal epidual anaethesia had been done, Keamine 0.5 mg·kg^-1 , tramadol 1 mg·kg^-1 and normal saline 5ml were administered into vein respectively. Changes in respiratory and circulatory system of parturients,neonatal Apgar scores and shivering and other side reaction were monitored and recorded. Results The occurrence rate of shivering was 5% in Group K; 10% in Group T;40% in Group N. There were statistical significanees（P 〈 0.05） by overall analysis of variance in three groups. There was no statistical significant difference between Group K and Group T（P 〉 0.05）. Heart rate and blood pressure increased in Group K at 10min after adminstration. There was no statistically significant difference between Group K and Group T（P 〉 0.05 ）in sedation score. Less visceral traction reaction was observed in Group K and Group T compared with Group N （P 〈 0.05）. More nausea and vomiting occurred in Group T than Group K. Conclusion Ketamine can effectively prevent shiver in caesarean section as well as tramadol. And there is no difference between them in sedative effect and preventing visceral traction reaction,but tramadol cause more nausea and vomiting than that of ketamine.