氯胺酮+异丙酚辅助小儿骶管阻滞麻醉的临床观察

Clinical study of paediatric caudal block analgesia assisted with ketamine and propofol

目的观察小儿骶管阻滞麻醉辅助氯胺酮＋异丙酚的安全性及效果，并与单纯辅助氯安酮或异丙酚作比较。方法选择下腹部、会阴部、下肢手术患儿105例，ASAⅠ～Ⅱ级，年龄1～7岁，在基础麻醉下行骶管阻滞，随机分为三组辅助用药（用微泵持续输注）：Ⅰ组，氯胺酮25μg．kg^-1．min^-1；Ⅱ组，异丙酚120μg．kg^-1．min^-1；Ⅲ组，氯胺酮10μg．kg^-1．min^-1异丙酚45μg．kg^-1．min^-1。结果三组综合麻醉效果满意，均能满足手术要求；术中镇静评分Ⅰ组4．23±0．6，Ⅱ组3．95±0．5，Ⅲ组4．12±0．6，组间无明显差异（P〉0．05）；注药后2minHR、MAP、SpO2变化有明显差异；术后苏醒时间Ⅰ组明显长于Ⅱ、Ⅲ组（P〈0．05）；苏醒期恶心呕吐、精神症状、躁动不安等不良反应的发生率Ⅲ组明显少于Ⅰ、Ⅱ组（P〈0．05）。结论氯胺酮＋异丙酚辅助小儿骶管阻滞麻醉效果可靠，安全性高，不良反应少于单纯应用氯胺酮或异丙酚辅助小儿骶管阻滞。

Objective To assess the analgesia effect and safety of paediatric caudal block analgesia assisted with ketamine and propofol. Methods One hundred and five paediatric patients （age： 1 -7years, ASA grade ： Ⅰ - Ⅱ degree. ） undertook caudal block analgesia. They were randomly divided into three groups according to different assisting drugs： group Ⅰ （ketamine 25 μg.kg^-1.min^-1）, group Ⅱ （propofol 120 μg.kg^-1.min^-1 ） and group Ⅲ（ ketaminel0 μg.kg^-1.min^-1 ＋ propofol 45 μg.kg^-1.min^-1 ）. Results The effects of analgesia were all satisfied in three groups. The HR, MAP and SpO2 had no difference in 2 min after injection. The wake - up time was longer in group Ⅰ （P 〈0.05）. The rate of bad reactions, such as nausea, vomit, restlessness and mental symptom, was lower in group Ⅲ（ P 〈 0.05 ）. Conclusion It＇s a safety and effective block analgesia method by using ketamine and propofol.