咪达唑仑复合氯胺酮应用于小儿基础麻醉的临床探讨

Different medication of midazolam combined with ketamine for basal anesthesia in children

目的探讨应用咪达唑仑复合氯胺酮不同给药方法在小儿基础麻醉中的优化方案。方法200例1～6岁,ASAⅠ～Ⅱ级患儿随机分成以下五组：A组为口服咪达唑仑0.7 mg/kg;B组为口服氯胺酮8 mg/kg;C组为肌注氯胺酮5mg/kg;D组为口服咪达唑仑0.5 mg/kg和氯胺酮4 mg/kg;E组为先口服咪达唑仑0.5 mg/kg,再肌注氯胺酮4 mg/kg。观察各组诱导结果及呼吸循环变化、不良反应。结果①A组与B组比较,A组起效更快（P〈0.01）,合作更好,不良反应较少;②A组、B组均比C组更合作,但不如C组起效更快;③D组和E组相比,患儿更合作,不良反应更少,但起效更慢,两组诱导效果无显著差异（P〉0.05）。结论咪达唑仑复合氯胺酮优于单独给药,对循环呼吸影响小;口服给药可行性更佳。

Objective To investigate the best medication of midazolam combined with ketamine for the induction anesthesia in children. Methods 200 children, aged 1 - 6 years; ASA grades Ⅰ - Ⅱ, were divided into five groups： group A, midazolam 0.7 mg/kg p. o. ; group B, ketamine 8 mg/kg p.o. ;group C, ketamine 5 mg/kg i.m. ; group D, midazolam 0.5 mg/kg ＋ ketamine 4 mg/kg p.o. ; group E, midazolam 0.5 mg/kg p.o. ＋ ketamine 4 mg/kg i. m. The efficacy of induction anesthesia, hemodynamic and respiratory change and adverse effect of the drugs were observed.Results ①The efficacy in group A was faster and the children cooperated better than in group B.②Group A and group B cooperated better but the efficacy was not faster than in group C（ P 〈 0.01）. ③Group D cooperated better and adverse effects were fewer than in group E,but the initiation of efficacy was slower, while there was no significant difference in induction of anesthesia （ P 〉 0.05）. Conclusions Midazolam combined with ketamine is better than either medicince alone for basal anesthesia in children, while there are fewer effects on blood circulaton and respiration. Oral administration is the best way of medication.