异丙酚复合小剂量氯胺酮在儿外手术中应用分析

目的对比不同血浆靶控浓度异丙酚复合小剂量氯胺酮在儿外应用效果。方法行儿外手术患者100例,随机分为R0、R1、R2、P0组即异丙酚3.0、2.0、1.5、1.0μg/ml复合小剂量氯胺酮0.5、1.0、1.5、2.0μg/ml组。监测心率、心电图和脉搏血氧饱和度,分别记录患者意识消失时间和恢复时间,并记录术中体动情况。结果R1、R2组恢复时间明显短于R0组。结论异丙酚与小剂量氯胺酮合用具有协同作用,但作用机制不同。以血浆靶控浓度2.0μg/ml异丙酚复合1.0μg/ml小剂量氯胺酮效果最佳。

Objective To compare the effects of target-controlled infusion(TCI)of propofol combination of ketamine invarious doses in patients undergoing paediatric operation.Methods 100 ASA Ⅰ-Ⅲ patients aged 2 m-8 yr,undergoing paediatric operation were randomly divided into four groups:group R0、 R1、 R2、 P0 were received propofol at a fixed target plasma concentration of 3.0,2.0,1.5,1.0 μg/ml combination of ketamine at 0.5,1.0,1.5,2.0 μg/ml,until loss of consciousness.The time required for loss of consciousness after TCI of propofol and ketamine was started(TLOC),for recovery of consciousness(TROC)after TCI of propofol and ketamine was stopped were recorded.Ramsay score and subject emotional experience score were also assessed.HR,ECG,SpO2 were monitored during anesthesia.Result TROC was significantly shorten in group R1,R2 than group R0.Subjective emotional experience score was better in group R0,R1 than in group R2,P0.MAP,SpO2,HR of similar magnitude reduced in four groups,but no serious cardiac and respiratory adverse effect were observed.Conclusion Propofol potentiates ketamine when given by TCI simultaneously for paediatric operation.The target plasma propofol concentration of 2.0 μg/ml in the presence of plasma ketamine concentration of 1.0 μg/ml is the appropriate target concentration,it can effectively attenuate the pain response and patients feel better.