七氟醚与氯胺酮应用于室间隔缺损患儿麻醉诱导的对比研究

Comparison study of sevoflurane with ketamine during induction in children with ventricular septum defect

目的：观察七氟醚与氯胺酮应用于室间隔缺损患儿麻醉诱导时的差异，以求找到更适合室间隔缺损患儿的诱导方法。方法：40例行室间隔修补术的3—6岁患儿，ASAⅠ～Ⅱ级，无神经系统及精神疾患，随机分为A、B两组，每组20例。A组诱导采用肌注氯胺酮6—8mg·kg^-1，阿托品0．01～0．015mg·ks^-1，待患儿意识消失后开放静脉，给予咪唑安定1mg，芬太尼10μg·kg^-1，万可松0．8～1．0mg·kg^-1，地塞米松2mg，气管插管。B组诱导采用面罩吸入七氟醚，待睫毛反射消失后开放静脉，给予芬太尼10μg·kg^-1，万可松0．8～1．0mg·kg^-1，地塞米松2mg，气管插管。记录各组患儿诱导时间，诱导时的顺从性评分、血流动力学变化及副反应，诱导后分泌物情况。结果：B组患儿的诱导顺从性评分、诱导时间及诱导后患几分泌物重量B组均明显小于A组，P〈0．01。A组患儿诱导后血压、心率显著升高（P〈0．01）。B组患儿诱导后血压无明显变化（P〉0．05）；心率显著减慢（P〈0．05）。B组患儿诱导后血压、心率均显著低于A组（P〈0．01）。A组有2例患儿诱导时缺氧发作，B组患儿未见任何副反应发生。结论：对于室间隔缺损患儿，吸入七氟醚麻醉诱导明显优于肌注氯胺酮。

Objective： To observe the difference between sevoflurane and ketamine during induction in children with ventricular septum defect. Methods： 40 children underwent ventricular septum repair were divided into two groups, each group was 20 children. Children in group A were induced by intramuscular injection ketamine. Children in group B were induced by inhalation sevoflurane to observe induction time, compliance during induction, change of hcmedynamics, amount of secretion, side effect in both groups. Results： Every index in group B was significantly lower than that in group A （ P 〈 0. 01 ）. Both the heart rate and blood pressure after induction were significantly higher than those before induction in group A （P 〈0. 01 ）, but only the heart rate was significantly lower after induction in group B （P 〈0. 05）. Two children had anoxie spell during induction in group A. Conclusion： Sevoflurane is more safely used than ketamine during induction in children with ventricular septum defect.