4种联合用药对腭裂矫治术苏醒和呼吸影响的临床研究

Clinical Study of the Revival and Respiratory Effects of Four Drug Combinations on Children with Palatorrphy

目的对比观察4组麻醉维持用药患儿术后的苏醒时间、苏醒后再嗜睡率及术中氯胺酮总用量、拔除气管导管后的呼吸管理情况,提高麻醉安全性.方法对80例施行小儿腭裂修补术的患儿随机分组使用4种不同配伍的麻醉维持用药,A组(n=20例):用氯胺酮+咪唑安定,B组(n=20例):用芬太尼+氯胺酮,C组(n=20例):用异氟醚+氯胺酮,D组(n=20例):用氯胺酮+七氟醚.结果(1)苏醒时间以C、D组<B组<A组(P<0.01);(2)苏醒后再嗜睡率以C、D组<B组<A组(P<0.01);(3)术中氯胺酮总用量以C、D组<B组<A组(P<0.01);(4)A组有13例患儿发生不同程度的上呼吸道梗阻,B、C、D组未发生.结论患儿术后的再嗜睡状态是产生和加重上呼吸道梗阻的主要原因,氯胺酮加咪唑安定组的患儿术后存在明显的再嗜睡状态和上呼吸道梗阻,改用芬太尼加氯胺酮、异氟醚/七氟醚加氯胺酮使氯胺酮的用量明显减少,患儿的苏醒时间缩短,再嗜睡状态减少和改善,使患儿的上呼吸道梗阻明显减轻和减少,有利于患儿术后的呼吸道管理,提高麻醉安全性.

Objective To observe and compare the effects of four kinds of anesthetic methods on the revival time, the rate of re - dormant after revival, the total Ketamine＇ s doses and the respiratory status after extubation, and to improve the safety of anesthesia. Method 80 cases of children with palatorrphy were randomly divided into 4 groups ： group A （ n = 20） given Midazolam and Ketamine, group B （ n = 20） given Fentanyl and Ketamine, group C （n = 20） given Isoflurane and Ketamine, and group D （n = 20） given Sevoflurane and Ketamine. Results （1） The revivaltimein group D and group C shortened （DandC〈B〈A, P〈0.01）; （2） the rate of re - dormant after extubation in group C and group D lessened （ D and C 〈 B 〈 A, P 〈 0. 01 ） ; （ 3 ） Ketamine＇ s total doses in group D and group C reduced （ D and C 〈 B 〈 A, P 〈 0. 01 ） ; （4） respiratory tract obstruction were detected in 13 cases in group A and no one were detected in group B, C, and D. Conclusions The decrease of the doses of Ketamine, the shortening of revival time, the improvement of re - dormant after extubation and the alleviation of upper respiratory tract obstruction are beneficial to the management of respiratory tract and the improvement of the safety of anesthesia.