硬膜外复合氯胺酮麻醉在小儿腹股沟斜疝腹腔镜手术中麻醉的有效性与安全性

The safety and efficacy of epidural block combined with ketamine anesthesia for laparoscopic surgery of pediatric indirect inguinal hernia

目的探讨硬膜外复合氯胺酮麻醉在小儿腹股沟斜疝腹腔镜手术中的有效性与安全性。方法36例ASAⅠ～Ⅱ级择期腹股沟斜疝腹腔镜手术小儿随机分为3组,每组12例。分别采用硬膜外复合氯胺酮麻醉(A组)、硬膜外复合全身麻醉(B组)和单纯全身麻醉(C组)。持续监护小儿HR、MAP、SpO2、PETCO2,术前、术中、术后进行比较,并行组间比较,记录主要药物用量,评估麻醉效果,记录可能发生的并发症和不良反应。结果A组在气腹前后HR、MAP无明显变化,B组和C组HR、MAP明显升高(P<0.05),3组病人PETCO2气腹后较气腹前升高,且B组和C组升高较A组更明显(P<0.05),3组病人SpO2变化不明显。3组病人PETCO2气腹结束后恢复至气腹前水平的时间相似。无严重不良反应病例发生。结论硬膜外复合氯胺酮麻醉能为小儿腹股沟斜疝腹腔镜手术提供安全有效的麻醉,且降低患者经济负担。

Objective To study the safety and efficacy of epidural block combined with ketamine anesthesia for laparoscopic indirect inguinal hernioplasty of young children comparing with epidural block combined with general anesthesia and with pure general anesthesia, Methods Thlrty-six pediatric patients with ASAⅠ～Ⅱ scheduled for laparoscopic indirect hernioplasty were randomly devided into three groups： group A, B and C （12 cases in each group） ,which received epidural combined with ketamine anesthesia, epidural combined with general anesthesia and pure general anesthesia, respectively. HR, MAP, SpO2, PETCO2, the amount of medecine, as well as the complications and side effects were recorded. Anesthetic effect was assessed. Results HR, MAP before and after CO2 insufflation were not significant defference in group A,while they significantly increased in group B and C. In three groups PrrCO2 after insufflation were upper comparing with pre-insufflation,and they were more significant in group B and C than that in group A（ P 〈 0. 05 ）. In three groups, SpO2 was not significantly deferent in comparing insufflation with desufflation, and the time of PrrCO2 geting down to the pre-insufflating value was similar. There were no serious complications or side effects. Conclusions Epidural block combined with ketamine anesthesia is not only enough for the requirement of laparoscopic indirect inguinal hernioplasty of young children but also more economical for them.