臂丛神经阻滞复合中/长链丙泊酚用于婴幼儿上肢手术的临床观察

Clinical efficacy of brachial block combined with middle/long chain propofol for the infant upper limb operations

目的探讨臂丛神经阻滞复合中/长链丙泊酚用于婴幼儿上肢手术的安全性和可行性。方法50例行上肢手术婴幼儿随机分为臂丛神经阻滞组(A组)和氯胺酮组(B组)。两组均用中/长链丙泊酚诱导后,A组0.20%罗哌卡因腋路臂丛阻滞,B组按需追加氯胺酮,两组术中均微量泵注中/长链丙泊酚。记录围手术期患儿HR、MAP、PET-CO2、SpO2,丙泊酚用量及其术后恶心呕吐等。结果术中A组循环、呼吸功能较B组稳定(P<0.05);肢体不良自主运动,术后恶心呕吐等较B组少(P<0.05);A组中/长链丙泊酚用量明显少于B组(P<0.01);与B组比,术后A组苏醒较快且平稳,恢复期精神症状较少(P<0.05)。结论罗哌卡因臂丛神经阻滞复合中/长链丙泊酚麻醉应用于婴幼儿上肢手术,镇痛完全,可减少不良反应及丙泊酚用量,使婴幼儿在手术期间呼吸循环更平稳,且术后苏醒快。

Objective To evaluate the anesthetic effect and safety of brachial chain propofol in the infant patients undergoing the upper limb operations. Methods block combined with middle/long Fifty infants undergoing the upper limb operations were randomly divided into two groups, including group A （brachial block combined with middle/long chain propofol） and group B （middle/long chain propofol combined with ketamine）. After anesthesia was induced with certain doses of propofol, in group A successful brachial block was accomplished with 0. 2% ropivacaine following micropump infusion of propofol, whereas in group B propofol was continuously micro-pump infused following ketamine if necessary. The heart rate （HR）, mean arterial blood pressure （MAP）, PETCO2 and pulse oxygen saturation （SpO2） were measured during intraoperative anesthesia. The post-operative awake time, the total dose of propofol and the rate of post-operative nausea and vomiting were also recorded. Results Compared with group B, circulation and respiratory function during surgery in group A is more stable （P〈0.05）. Limbs＇ dys-automatie action and the rates of postoperative nausea and vomiting in group A decreased more significantly than those in group B （P〈0. 05）. Compared with group B postoperative palinesthesia in group A was quicker and more stable and psychiatric symptom during recovery stage was inhibited more notably. The total dose of propofol in group A was less than in group B. （P〈0. 05）. Conclusion In the infant patients undergoing the upper limb operations, brachial block combined with middle/long chain propofol is superior to middle/long chain propofol combined with ketamine in maintaining hemodynamic stability and reducing the total dose of propofol and the incidences of postoperative nausea and vomiting.