长托宁、力月西作为氯胺酮麻醉前用药的观察

Effects of Penehyclidine Hydrochloride Combined with Midazolam as Premedication before Narcotic Ketamine

目的观察长托宁（盐酸戊乙奎醚）复合力月西（咪达唑仑）作为麻醉前用药，在小儿氯胺酮麻醉中对血压、心率的影响及镇静程度和麻醉苏醒期的精神反应情况。方法40例3～6岁患儿随机分为长托宁组和阿托品组，每组20例，均行氯胺酮静脉麻醉。纪录各时点的MAP、HR、SPO2，观察患者用长托宁或阿托品复合力月西后的镇静程度和苏醒期的精神反应情况。结果2组病例用药后的镇静程度及麻醉苏醒期的精神反应情况比较差异无统计学意义（P〉0．05）。HR、MAP与基础值比较。阿托品组用药后HR明显增快，MAP升高（P〈0．05）；长托宁组HR、MAP基本不变。氯胺酮麻醉后，阿托品组HR显著增快，MAP显著升高（P〈0．01），长托宁组HR、MAP略有上升，但不显著（P〉0．05），其中HR未超过基础值。结论长托宁或阿托品复合力月西作为小儿氯胺酮麻醉前用药，均可产生良好的镇静作用，减少麻醉苏醒期的精神反应，但长托宁可使患儿HR、MAP保持稳定，较阿托品更适合作为小儿氯胺酮麻醉的麻醉前用药。

Objective To observe the effects of Penehyclidine hydrochloride combined with Midazolam as a premedication before narcotic Ketamine on the blood pressure, heart rate, the degree of sedative action, and the spiritual reaction in anesthesia recovery period in children. Methods 40 cases of 3 ～ 6 years old were randomly divided into Penehyclidine hydrochloride group （group A, n = 20 ） and Atropine groups（ group B, n =20 ）. Before intravenous narcotic Ketamine, Group A was administered with Penehyclidine hydrochloride and Group B with Atropine combined by Midazolam. The MAP, HR and SPO2 were observed in different point of time. The degree of sedative action and the spiritual reaction in anesthesia recovery period were observed. Results There was no significant difference in the degree of sedative action and the spiritual reaction in anesthesia recovery period after the administration between the two groups （ P 〉 0.05 ）. Compared with the basis value, HR increased rapidly and MAP rose in Group B （ P 〈 0.05 ）, but not in the Group A. Both HR and MAP increased significantly （ P 〈 0.01 ） after intravenous narcotic Ketamine in Group A while not obviously in Group B （ P 〉 0.05 ）. Conclusions Both Penehyclidine hydrochloride and Atropine combined with Midazolam as a premedication before narcotic Ketamine have obvious sedative action and can reduce the spiritual reaction in anesthesia recovery period. Penehyclidine hydrochloride enables HR and MAP to remain stable and is more adequate as a premedication before narcotic Ketamine.