【摘要】 目的 觀察小劑量氯胺酮在健忘鎮(zhèn)痛麻醉輔助局部麻醉（局麻）剖宮產(chǎn)中的應(yīng)用。方法 選擇1200例剖宮產(chǎn)的孕婦,隨機(jī)分為單純局麻組(L組)、氟芬強(qiáng)化局麻組(F組)和健忘鎮(zhèn)痛麻醉組(J組),每組400例。L組單純局麻;F組局麻術(shù)中輔以氟哌利多500 mg,芬太尼015 mg;J組在F組基礎(chǔ)上輔以氯胺酮,觀察各組患者麻醉誘導(dǎo)至胎兒娩出時(shí)間;新生兒1、5 min Apgar評(píng)分;手術(shù)中血壓相對(duì)于基礎(chǔ)值的波動(dòng)情況;手術(shù)中及手術(shù)后出血情況及麻醉滿意度。 結(jié)果 J組與L組和F組比較,胎兒娩出時(shí)間無(wú)顯著差別;Apgar評(píng)分提高;手術(shù)中孕婦血壓波動(dòng)不明顯;手術(shù)中及手術(shù)后出血量無(wú)明顯增加,麻醉滿意度明顯提高。 結(jié)論 由小劑量氯胺酮輔助實(shí)施的健忘鎮(zhèn)痛麻醉在局麻剖宮產(chǎn)中優(yōu)于單純局麻和氟芬強(qiáng)化局麻,在剖宮產(chǎn)中尤其急診剖宮產(chǎn)中值得推廣。【Abstract】 Objective To observe the application of lowdose ketamine during the local anesthesia in cesarean section assisted by analgestic and amnestic anesthesia. Methods A total of 1200 cases who need cesarean section were randomly divided into 3 groups (400 cases in each group): simple local anesthesia group (group L), droperidolfentanyl strengthen local anesthesia group (group F) and analgestic and amnestic anesthesia group (group J). Group L was only local anesthesia. Group F was local anesthesia supplemented by droperidol 500 mg, fentanyl 015 mg. Group J was supplemented with ketamine on the basis of group F. Then the time from anesthesia to the fetus delivery, Neonatal Apgar score of one and five minutes, the blood pressure fluctuations, amount of bleeding in or after surgery and the satisfaction of anesthesia were all observed. Results Compared with group L and F, the delivery time was no significant difference, Apgar score increased, blood pressure fluctuations in pregnant women was not obviously varied, amount of bleeding in or after surgery had no significantly increase, and the satisfaction of anesthesia improved markedly all in group J. Conclusions The analgestic and amnestic anesthesia assisted by lowdose ketamine, in cesarean section, is better than local anesthesia and strengthen local anesthesia by droperidolfentanyl, which is worthy to be popularized, especially in emergency caesarean section.