目的 观察亚麻醉剂量艾司氯胺酮用于预防剖宫产术中卡前列素应用后恶心呕吐的有效性和安全性。 方法 纳入135例行择期剖宫产的单胎足月产妇，年龄20 ~ 40岁，ASAⅠ-Ⅱ级。按随机数字表法，分为3组（每组45例）：生理盐水组（C组）、帕洛诺司琼组（P组）和艾司氯胺酮组（E组）。所有产妇均行腰-硬联合麻醉，麻醉平面为T_5～7。在断脐带后，子宫体肌注卡前列素氨丁三醇，同时C组静脉注射生理盐水、P组静脉注射帕洛诺司琼、E组静脉注射艾司氯胺酮。记录卡前列素给药后至产妇离室时恶心、呕吐、胸闷事件，同时记录入室（T₀）、静脉注射艾司氯胺酮前1 min（T₁）、给药后2 min（T₂）、5 min（T₃）、15 min（T₄）和30 min（T₅）时产妇MAP、HR、SpO₂和Ramsay评分，出手术室时产妇满意度。 结果 与C组相比，E组恶心、呕吐、胸闷发生率低（P < 0.05）；与P组相比，E组恶心、胸闷发生率低（P < 0.05）。与C组相比，E组满意度高（P < 0.05）；与P组相比，E组满意度高（P < 0.05）。其余组间恶心、呕吐、胸闷、满意度差异无统计学意义（P > 0.05）。 结论 亚麻醉剂量艾司氯胺酮可有效降低剖宫产产妇应用卡前列素氨丁三醇引起的恶心呕吐等不良反应，同时提高产妇围术期的满意度。

Objective To evaluate the efficacy and safety of a subanesthetic dose of esketamine in preventing postoperative nausea and vomiting following carboprost administration during cesarean section. Methods One hundred thirty?five full?term singleton parturients， ASAⅠ-Ⅱ， aged 20 - 40 years， scheduled for elective cesarean section， were recruited. They were randomly assigned to three groups （n = 45）： the normal saline group （Group C）， the palonosetron group （Group P）， and the esketamine group （Group E）. All parturients received combined spinal?epidural anesthesia， achieving a sensory level of T_5?7. Following umbilical cord clamping， carboprost tromethamine was injected into the uterine body. Concurrently， Group C received intravenous normal saline， Group P received palonosetron， and Group E received esketamine. The incidence of nausea， vomiting， and chest discomfort was recorded from the time of carboprost administration until the parturients left the operating theater. Additionally， mean arterial pressure （MAP）， heart rate （HR）， oxygen saturation （SpO₂）， and Ramsay sedation scores were measured at six time points： upon entering the room （T₀）， 1 minute before intervention （T₁）， 2 minutes （T₂）， 5 minutes （T₃）， 15 minutes （T₄）， and 30 minutes （T5） post?intervention. Maternal satisfaction was evaluated as the parturients left the operating room. Results Compared with group C， the incidence of nausea， vomiting， and chest discomfort in group E was significantly lower （all P < 0.05）. Additionally， group E showed a significantly lower incidence of nausea and chest discomfort compared to group P （all P < 0.05）. In terms of maternal satisfaction， group E reported significantly higher levels than both group C （P < 0.05） and group P （P < 0.05）. No significant differences were observed in the incidence of nausea， vomiting， chest discomfort， or satisfaction between the other groups （P > 0.05）. Conclusion The administration of subanesthetic doses of esketamine significantly decreases the incidence of adverse effects such as nausea， vomiting， and chest tightness that are commonly associated with carboprost tromethamine use during cesarean sections， thereby enhancing patient satisfaction in the perioperative period.