丙泊酚复合瑞芬太尼和氯胺酮用于小儿非插管全麻的临床观察

Clinical efficacy of remifentanil or ketamine for pediatric general anesthesia

目的观察丙泊酚-瑞芬太尼麻醉与丙泊酚-氯胺酮麻醉用于小儿非插管全麻短小手术的临床效果和安全性。方法选择40例短小手术患儿平分为瑞芬太尼组和氯胺酮组。两组麻醉诱导和维持分别选用微量泵输注丙泊酚-瑞芬太尼和丙泊酚-氯胺酮,记录两组患儿围手术期心率(HR)、平均动脉压(M AP)、呼吸频率(RR)和脉搏氧饱和度(SpO2)的变化,并同时记录术后清醒时间、麻醉恢复时间以及术后恶心呕吐发生情况。结果与术前相比,手术期间瑞芬太尼组HR、RR和M AP均有下降,而氯胺酮组无变化。瑞芬太尼组患儿出现恶心呕吐。结论微量泵注丙泊酚-氯胺酮麻醉在维持患儿血流动力学稳定、减少呼吸抑制和术后恶心呕吐发生率等方面优于复合瑞芬太尼,使小儿非插管全身麻醉更平稳安全。

Objective To evaluate the anesthetic effect and safety of remifentanil combined with propofol or ketamine combined with propofol in pediatric patients undergoing short and minor operations under general anesthesia without tracheal intubation. Methods Forty children who were going to receive short and minor operations were randomly divided into two groups ：group R （group remifentanil） and group K （group ketamine）. Anesthesia was induced and maintained with micro-pump infusion of propofol and remifentanil or propofol and ketamine. The heart rate （HR）, mean arterial blood pressure （MAP）, respiration rate （RR） and pulse oxygen saturation （SpOz） in two groups were measured during intraoperative anesthesia. The post-operative awake time, anesthesia recovery time and the rate of postoperative nausea and vomiting were also recorded. Results Compared with pre-operation, MAP and HR during surgery in group R decreased significantly after anesthesia, whereas MAP and HR in group K did not alter at all （P〈 0.05）. The incidences of respiratory depression and postoperative nausea and vomiting in group R was notably higher than group K （P〈0.05）. Conclusion Micro-pump infusion of ketamine and propofol is superior to remifentanil and propofol in aspects of maintaining hemodynamic stability and reducing the incidences of respiratory depression and postoperative nausea and vomiting. Thus this regimen makes pediatric general anesthesia without tracheal intubation more stable and safer.