异丙酚、氯胺酮对腭裂患儿全麻手术中心率变异性的影响

Influence of propofol,ketamine on heart rate variability( HRV )of children undergoing general anesthesia for palatoplasty

目的：研究异丙酚与氯胺酮麻醉对小儿自主神经功能的影响。方法：35例ASAⅠ～Ⅱ级腭裂手术患儿，随机分为2组：插管后Ⅰ组（氯胺酮组，n=17）静注氯胺酮（1～2mg／kg），Ⅱ组（异丙酚组，n=18）异丙酚4～8mg／（kg·h）微量泵输注。监测麻醉前（T0）、插管后5min（T1）、切皮（T2）、手术开始后1h（T3）、术毕（T4）及拔管后（T5）低频（LF）、高频（HF）、低频高频比（LF／HF）和总功率（LF＋HF）及MAP、HR、SpO2各值。结果：T1-T4各时点LF、HF、LF／HF及LF＋HF显著降低（P〈0．05）。拔管后HRV各值基本恢复至术前水平（P〉0．05）。2组比较，T2-T5各时点Ⅱ组HRV各值明显低于Ⅰ组（P〈0．05）。T2-T5 HR、MAPⅡ组明显低于Ⅰ组（P〈0．05）。T5时点SpO2 2组明显低于T0-T4（P〈0．05）。Ⅰ组拔管时间、清醒时间明显较Ⅱ组长（P〈0．05），且躁动哭闹及术后恶心呕吐发生率明显高于Ⅱ组（P〈0．05）。结论：异丙酚在麻醉中降低血压、心率和抑制自主神经功能的作用强于氯胺酮，术后拔管时间、苏醒时间、恶心呕吐及躁动哭闹的发生明显优于氯胺酮。

Objective：To study the influence of anesthesia with propofol or with ketamine on autonomic nerve function in children. Methods： 35 children aged 3 -8 years old undergoing general anesthesia for palatoplasty with ASA Ⅰ - Ⅱ cleft palate were randomly divided into 2 groups, group Ⅰ （ ketamine group, n = 17 ） and group Ⅱ（ propofol group, n = 18）. The low frequency （LF） , high frequency （HF） , ratio of low frequency and high frequency （ LF/ HF） ,total power （ LF ＋ HF）, MAP, HR and SpO2 were recorded before anesthesia （T0）, after intubation （T1）, incision of skin（ T2 ）, 1h after the begining of operation（ T3 ）, after the completion of operation （T4） and extubation （T5）. Results：In the 2 groups the values of LF, HF, LF/HF and LF ＋ HF at T1 - T4 were significantly lower than those at T0 （ P 〈 0.05 ）. The indexes of HRV at extubation were recovered to the level of those before anesthesia （ P 〉 0.05）. In group Ⅱ ,the indexes of HRV at T2 -T5 were significantly lower than those in group Ⅰ （P 〈 0.05 ）. In group Ⅱ ,HR and MAP at T2 -T5 were remarkably lower than those in group Ⅰ （P〈0.05）. SpO2 at T5 was significantly lower than that at T0 -T4 in both groups（ P 〈0.05 ）. The time of extubation and awake in group Ⅰ were remarkably longer than that in group Ⅱ （P 〈 0. 05 ）, furthermore the incidences of restlessness, crying, nausea and vomiting in group Ⅰ were significantly higher than those in group Ⅱ （ P 〈 0.05 ）. Conclusion： Propofol is more effective than ketamine in decreasing BP and HR, inhibiting autonomic nerve during anesthesia, decreasing the time of extubation and awakening and inhibiting nauses, vomiting, restlessness and crying.