七氟烷、氯胺酮静吸复合麻醉用于小儿腹股沟斜疝修补术的临床观察

Clinical application of combined anesthesia with vein-inhalation of sevoflurane/ketamine in pediatric oblique inguinal hernia

目的观察七氟烷、氯胺酮静吸复合用于小儿腹股沟斜疝修补术的效果及不良反应，评价静吸复合全麻在小儿术中的临床应用。方法选择ASAⅠ～Ⅱ级择期行腹股沟斜疝修补术住院患儿120例，随机分为七氟烷组（S组）、七氟烷复合氯胺酮组（KS组）和氯胺酮组（K组），每组40例。患儿入室后开放上肢静脉，S组术中吸入3％-5％七氟烷，维持在1．3～1．5肺泡气最低有效浓度（minimal alveolar concentration，MAC）；KS组术中吸入1％～3％七氟烷，维持在0．6—1．0MAC，同时静脉输注0．5mg·kg^-1·h^-1氯胺酮；K组手术开始时静脉注射2mg·kg^-1氯胺酮，术中持续静脉输注0．5mg·kg^-1·h^-1氯胺酮。术中患儿始终保持自主呼吸，常规监测平均动脉压（MAP）、心率（HR）、脉搏血氧饱和度（SpO2）、呼吸频率（RR）、苏醒时间、清醒时间和不良反应。结果①与术前相比，KS组患儿围术中呼吸、循环变化不明显（P〉0．05），而S组和K组RR术中较低，HR及MAP较术前高（P〈0．05）。②K组患儿苏醒时间和清醒时间较S组及KS组明显延长（P〈0．05）。③S组及K组患儿呛咳、恶心、呕吐、躁动、呼吸抑制等不良反应发生率明显高于KS组（P〈0．05或P〈0．01）。结论七氟烷复合氯胺酮可安全用于小儿全身麻醉，不良反应发生率低。

Objective To observe the clinical effect and adverse reactions of sevoflurane combined with ketamine in pediatric oblique inguinal hernia neoplasty and evaluate the clinical application of general anesthesia combined with vein - inhalation in pediatric surgery. Methods 120 inpatients with ASA Ⅰ - Ⅱ undergoing hernia neoplasty operation were randomly divided into 3 groups （n = 40 each） ： sevoflurane group （S group）, sevoflurane / ketamine group （KS group） and ketamine group （ K group）. All patients had a vein of upper extremity opened. Patients in S group were assigned to receive sevoflurane （3% -5% ） and anesthesia was maintained at 1.3 - 1.5 MAC （minimum alveolar concentration）.In KS group, patients received sevoflurane （ 1% ~ 3% ） combined with intravenous drip of 0.5 mg · kg^-1 ·h^-1 ketamine. In group K, 2 mg · kg^-1 ketamine was given intravenously at the onset of operation, followed by continuous intravenous drip 0.5 mg · kg^ - 1· h^ - 1 during operation. Throughout the operation, all the patients had autonomous respiration voluntary respiration. The heart rate （HR）, mean arterial blood pressure （MAP）, respiratory rate （RR）, saturation of pulse oxygen （ SpO2 ） and adverse reactions were monitored during and after operation. The time of palinesthesia and consciousness were recorded. Results The HR and MAP were significantly lower in group KS than in groups K and S during operation （ P 〈 0.05 ）. But the RR was significantly lower in group K and S than those in group KS （ P 〈 0.05 ） . The time of palinesthesia and consciousness in group K were significantly longer than that in groups S and KS after operation （P 〈0.05）. The incidence of agitation, nausea -vomiting, dyspnea, etc. were significantly lower in group KS than those in groups K and S （ P 〈 0.05 or P 〈 0.01 ）. Conclusion It is safe and feasible to give sevoflurane combined with ketamine anesthesia in pediatric operations, with an incidence of adverse reactions reduced.