肌注氯胺酮用于法乐氏四联症体外循环转机前麻醉的临床观察

Clinical research of ketamine with intramuscular injection in patients with tetralogy of Fallot before establishing cardiopulmonary bypass

目的 :寻求法乐氏四联症体外循环建立前最佳的麻醉方法。方法 :将 30例法乐氏四联症患儿按全麻用药及用药途径不同分为 3组 (n =10 ) ,对比观察诱导前及诱导后 1、5min及手术切皮、锯胸骨、体循环管道建立时HR、RPP、SpO2 变化。Ⅰ组 :乙咪酯 (0 .2mg/kg) ,Ⅱ组 :静注氯胺酮 (1.5mg/kg) ,Ⅲ组 :肌注氯胺酮 (5mg/kg)。 结果 :与诱导前比较 ,Ⅰ、Ⅱ两组的HR及RPP分别在切皮后及诱导后 1min明显增快 (P <0 .0 5 ) ,而Ⅲ组从诱导至体外循环通道建立的过程中HR与RPP均无明显变化。结论 :肌注氯胺酮组心率、RPP较其它二组更趋稳定 ,无一例缺氧发作 。

Objective To investigate the best anesthetic methods before establishing cardiopulmonary bypass in patients with tetralogy of Fallot.Methods According to the kinds and routes of general anesthetics,thirty patients with tetralogy of Fallot were assigned to three groups(each group, n 10):groupⅠand Ⅱ by intravevous injection of etomidate(0.2 mg/kg) and ketamine(1.5 mg/kg),group Ⅲ by intramuscular injection of ketamine(5 mg/kg).The changes of heart rate(HR),rate-pressure product(RPP) and pulse oximeter oxygen saturation(SpO2) were observed before induction,at 1 and 5 min after induction,at moments of skin incision,sternotomy and establishing extracorporeal circulation.Results HR and RPP after skin incision significantly increased compared with that before induction in groupⅠand Ⅱ( P <0.05),while that in group Ⅲ was not significantly changed.Conclusions With more stable in RPP and HR in group Ⅲ,the anesthetic method in group Ⅲ was better than in groupⅠand Ⅱ.