中国医药
中國醫藥
중국의약
CHINA MEDICINE
2015年
6期
869-871
,共3页
陈岱莉%齐晓非%庄仁坤%黄晓雷%李元涛
陳岱莉%齊曉非%莊仁坤%黃曉雷%李元濤
진대리%제효비%장인곤%황효뢰%리원도
剖宫产术%麻醉,脊柱%寒战%氯胺酮%曲马多
剖宮產術%痳醉,脊柱%寒戰%氯胺酮%麯馬多
부궁산술%마취,척주%한전%록알동%곡마다
Cesarean section%Anaesthesia,spinal%Shivering%Ketamine%Tramadol
目的 探讨小剂量氯胺酮和曲马多预防剖宫产术蛛网膜下腔麻醉后寒战的效果.方法 纳入择期接受剖宫产术的产妇120例,按随机数字表法将产妇分为氯胺酮组(40例)、曲马多组(40例)和对照组(40例).胎儿娩出后,氯胺酮组静脉注射氯胺酮0.25 mg/kg,曲马多组静脉注射曲马多0.25 mg/kg,对照组给予相同体积0.9％氯化钠注射液.于给药后15、30和45 min观察寒战程度、测量鼓膜温度,观察不良反应发生情况.结果 给药后各时点产妇寒战程度氯胺酮组(15 min:无寒战;30 min:1例1级;45 min:1例1级)和曲马多组(15 min:1例1级;30 min:1例1级、1例2级;45 min:2例1级、1例2级)均低于对照组(15 min:8例1级、7例2级、5例3级;30 min:9例1级、8例2级、5例3级;45 min:10例1级、8例2级),差异均有统计学意义(均P ＜0.05),氯胺酮组与曲马多组比较差异无统计学意义(P＞0.05).3组产妇给药后15、30、45 min鼓膜温度与基础鼓膜温度比较均降低,其中氯胺酮组[(36.06 ±0.14)、(36.11 ±0.13)、(36.26±0.12)℃]明显高于于对照组[(35.82±0.22)、(35.94 ±0.18)、(36.07±0.19)℃]和曲马多组[(35.87±0.20)、(35.95±0.16)、(36.07±0.12)℃],差异均有统计学意义(均P＜0.05).给药后各时间点氯胺酮组和曲马多组产妇均出现不同程度镇静,对照组产妇均无镇静发生.对照组1例出现恶心,氯胺酮组1例出现恶心、1例发生呕吐,曲马多组2例出现恶心、2例发生呕吐,3组均未发生幻觉和眼球震颤.结论 预防性给予小剂量氯胺酮和曲马多可明显减少剖宫产术蛛网膜下腔麻醉后寒战的发生,且没有明显的不良反应.
目的 探討小劑量氯胺酮和麯馬多預防剖宮產術蛛網膜下腔痳醉後寒戰的效果.方法 納入擇期接受剖宮產術的產婦120例,按隨機數字錶法將產婦分為氯胺酮組(40例)、麯馬多組(40例)和對照組(40例).胎兒娩齣後,氯胺酮組靜脈註射氯胺酮0.25 mg/kg,麯馬多組靜脈註射麯馬多0.25 mg/kg,對照組給予相同體積0.9％氯化鈉註射液.于給藥後15、30和45 min觀察寒戰程度、測量鼓膜溫度,觀察不良反應髮生情況.結果 給藥後各時點產婦寒戰程度氯胺酮組(15 min:無寒戰;30 min:1例1級;45 min:1例1級)和麯馬多組(15 min:1例1級;30 min:1例1級、1例2級;45 min:2例1級、1例2級)均低于對照組(15 min:8例1級、7例2級、5例3級;30 min:9例1級、8例2級、5例3級;45 min:10例1級、8例2級),差異均有統計學意義(均P ＜0.05),氯胺酮組與麯馬多組比較差異無統計學意義(P＞0.05).3組產婦給藥後15、30、45 min鼓膜溫度與基礎鼓膜溫度比較均降低,其中氯胺酮組[(36.06 ±0.14)、(36.11 ±0.13)、(36.26±0.12)℃]明顯高于于對照組[(35.82±0.22)、(35.94 ±0.18)、(36.07±0.19)℃]和麯馬多組[(35.87±0.20)、(35.95±0.16)、(36.07±0.12)℃],差異均有統計學意義(均P＜0.05).給藥後各時間點氯胺酮組和麯馬多組產婦均齣現不同程度鎮靜,對照組產婦均無鎮靜髮生.對照組1例齣現噁心,氯胺酮組1例齣現噁心、1例髮生嘔吐,麯馬多組2例齣現噁心、2例髮生嘔吐,3組均未髮生幻覺和眼毬震顫.結論 預防性給予小劑量氯胺酮和麯馬多可明顯減少剖宮產術蛛網膜下腔痳醉後寒戰的髮生,且沒有明顯的不良反應.
목적 탐토소제량록알동화곡마다예방부궁산술주망막하강마취후한전적효과.방법 납입택기접수부궁산술적산부120례,안수궤수자표법장산부분위록알동조(40례)、곡마다조(40례)화대조조(40례).태인면출후,록알동조정맥주사록알동0.25 mg/kg,곡마다조정맥주사곡마다0.25 mg/kg,대조조급여상동체적0.9％록화납주사액.우급약후15、30화45 min관찰한전정도、측량고막온도,관찰불량반응발생정황.결과 급약후각시점산부한전정도록알동조(15 min:무한전;30 min:1례1급;45 min:1례1급)화곡마다조(15 min:1례1급;30 min:1례1급、1례2급;45 min:2례1급、1례2급)균저우대조조(15 min:8례1급、7례2급、5례3급;30 min:9례1급、8례2급、5례3급;45 min:10례1급、8례2급),차이균유통계학의의(균P ＜0.05),록알동조여곡마다조비교차이무통계학의의(P＞0.05).3조산부급약후15、30、45 min고막온도여기출고막온도비교균강저,기중록알동조[(36.06 ±0.14)、(36.11 ±0.13)、(36.26±0.12)℃]명현고우우대조조[(35.82±0.22)、(35.94 ±0.18)、(36.07±0.19)℃]화곡마다조[(35.87±0.20)、(35.95±0.16)、(36.07±0.12)℃],차이균유통계학의의(균P＜0.05).급약후각시간점록알동조화곡마다조산부균출현불동정도진정,대조조산부균무진정발생.대조조1례출현악심,록알동조1례출현악심、1례발생구토,곡마다조2례출현악심、2례발생구토,3조균미발생환각화안구진전.결론 예방성급여소제량록알동화곡마다가명현감소부궁산술주망막하강마취후한전적발생,차몰유명현적불량반응.
Objective To compare the efficacy of low dose of ketamine and tramadol in prevention of shivering after spinal anaesthesia in cesarean section.Methods Totally 120 partients receiving selective cesarean section were enrolled and randomly divided into ketamine group (40 cases) injected with ketamine (0.25 mg/kg) intravenously,tramadol group (40 cases) injected with tramadol (0.25 mg/kg) intravenously,and control group (40 cases) injected with 0.9％ sodium chloride injection.The shivering degree,tympanic temperature and side effects such as sedation,nausea and vomiting,hallucinations and nystagmus were observed and recorded 15,30 and 45 min after administration.Results At each time point,shivering degree in ketamine group (15 min:0 of Shivering,30 min:1 of grade 1,45 min:1 of grade 1) and tramadol group (15 min:1 of grade 1,30 min:1 of grade 1,1 of grade 2,45 min:2 of grade 1,1 of grade 2) was all significantly lower than that in control group (15 min:8 of grade 1,7 of grade 2,5 of grade 3,30 min:9 of grade 1,8 of grade 2,5 of grade 3,45 min:10 of grade 1,8 of grade 2) (all P ＜ 0.05),while there were no significant differences between ketamine and tramadol group (P ＞ 0.05).The tympanic temperature of three groups all decreased compared with basic tympanic temperature,and the temperature in ketamine group [15 min:(36.06 ± 0.14)℃,30 min:(36.11 ±0.13)℃,45 min:(36.26 ±0.12)℃] was significantly higher than that in control group [15 min:(35.82 ±0.22)℃,30 min:(35.94±0.18)℃,45 min:(36.07±0.19)℃] and tramadol group [15 min:(35.87±0.20)℃,30 min:(35.95 ± 0.16) ℃,45 min:(36.07 ± 0.12) ℃] with statistical differences (all P ＜ 0.05).Sedation occurred in both ketamine group and tramadol group,but it did not occur in control group.Nausea occurred in 1 case in control group,1 case in ketamine group and 2 case in tramadol group;vomiting occurred in 1 case in ketamine group and 2 case in tramadol group;no hallucinations and nystagmus occurred in all three groups.Conclusion Prophylactical administration of low dose ketamine and tramadol can reduce shivering after spinal anaesthesia in cesarean section without significant side effects.
