气管插管全麻与硬膜外复合静脉麻醉用于妇科腹腔镜手术的比较

The Clinical Observation on Pediatric Anesthesia with Ketamine Hydrochloride Combined With Midazdam

目的:比较气管插管全麻与硬膜外复合静脉麻醉用于妇科腹腔镜手术的麻醉效果与安全性。方法:选择40例ASAⅠ～Ⅱ级择期行妇科腹腔镜手术的患者,随机分为气管插管全麻组(Ⅰ组)和硬膜外复合静脉麻醉组(Ⅱ组),每组20例。Ⅰ组常规气管插管全麻,机械通气。Ⅱ组使用硬膜外复合静脉麻醉保留自主呼吸。记录两组患者麻醉前、气腹后5min、气腹后15min、放气后10min。血压(BP)、心率(HR)、呼吸频率(RR)、血氧饱和度(SPO2)、呼吸末二氧化碳(PETCO2)分压及清醒后的不适主诉,术者的满意度等。结果:气腹后5min、15min,Ⅱ组呼吸未二氧化碳(PETCO2)均显著高于Ⅰ组,P<0.05。与术前相比Ⅱ组气腹后15min血压(BP)明显较术前降低,P<0.05。呼吸频率增快,P<0.05。结论:气管插管静脉全麻更适合用于妇科腹腔镜手术的麻醉,尤其在防止低血压,控制患者二氧化碳蓄积方面明显优于硬膜外复合静脉麻醉。

Objective: Observing on the clinical effects and safety of pediatric anesthesia in small and medium operations by comparing single ketamine hydrochloride with ketamine hydrochloride combined with midazdam. Method: Forty ASI Ⅰ～Ⅱ pediatric patients for small and medium operations were selected and divided into two groups at random. The observation group was applied with ketamine hydrochloride combined with midazdam, and the control group with single ketamine hydrochloride. The observed contents including heart rate (HR), respiratory rate (RR), mean blood pressure (MAP), blood oxygen saturation (SPO 2), end-tidal CO 2 pressure (PETCO 2), consciousness time and side effects et al, were observed at time points of 5 minutes, 10 minutes, and 15 minutes prior to anesthesia and post-anesthesia, respectively. Result: In group K, AMP and HR increased after anesthesia, by comparison with those before anesthesia P value was less than 0.01(P <0.01). In group K.L, AMP and HR increased, by comparison with those before anesthesia there was no significance (P>0.05). Respiratory rates all decreased in two groups. PETCO 2 of two groups were compared with those before anesthesia, respectively, P values were less than 0.05 (P <0.05). Although SPO 2 changed, it ranged in a safe limitation which was permitted clinically, and there was no significant difference of SPO 2 before anesthesia compared with post-anesthesia. The post-operative side effects including dysphoria and blubbering had a significant difference ( P<0.05) by comparison of group K with Group K.L. Conclusion: Ketamine hydrochloride combined with midazdam that were applied for pediatric anesthesia in small and medium operations had a little influence on hemodynamics and respiration, so it was a safe and convenient method for pediatric anesthesia, and had much advantage over utilization of single ketamine hydrochloride.