瑞芬太尼复合咪达唑仑、氯胺酮、丙泊酚在小儿全凭静脉麻醉中的应用

Appliation of Remifentanil Combined Midazolam,Ketamine and Propofol in Total Intraverous Anesthesia of Children

目的观察咪达唑仑、氯胺酮、丙泊酚复合与伍用瑞芬太尼在小儿全凭静脉麻醉中的麻醉效果。方法40例患儿(ASAⅠ～Ⅱ)随机分为两组,A组(实验组)和B组(对照组),两组均静脉注射氯胺酮负荷量2mg/kg,咪达唑仑0.06mg/kg,以微量泵持续输注丙泊酚[速度4～6mg(/kg.h)]。A组加用瑞芬太尼,以微量泵持续输注,开始以4～6μg/min速度输注。3min左右钳夹患儿无体动即可开始手术,随后以适当速度维持(2μg/min)。B组以微量泵持续输注氯胺酮[2～3mg/kg.h],在切皮前一般需追加氯胺酮。两组均在相应不同时间点观察MAP、HR、SPO2、RR及动脉血气分析。结果术毕清醒时间:A组(13.53±3.72)min,B组(34.47±7.46)min,麻醉后各时间点MAP、HR各项值与麻醉前相比,A组无统计学意义(P>0.05),B组显著高于麻醉前水平(P<0.05);组间比较,有统计学意义(P<0.05);各时间点血气分析值及SPO2、RR值两组间无统计学意义(P>0.05)。结论A组术中血流动力学稳定,与麻醉前比较无明显变化,镇痛完全,术后清醒时间较短,麻醉效果优于B组。

Objective To study the effect of midazolam-ketamine-propofol compound and combined with remifentanil in total intraverous anesthesia of children. Methods Fourty ASA Ⅰ - Ⅱ children were randomly divided into group A（experiential group）and B（control group）. In the two groups, anesthesia was induced with ketamine 2mg/kg, midazolam 0.06mg/kg and with maintenance of miro-pump injection of propofol（4 - 6mg/kg.h）. In the group A, remifentanil was maintained intravenously by 4- 6 μg/min in the beginning. About 3 minutes later,operation was allowed to begin and then remifentanil was maintained by 2μg/min intravenously. In the group B,ketamine was maintained intravenously by 2 - 3mg/（kg.h） and it is necessary that ketamine should be injected intravenously before operation in general. In the two groups, monitor programs were MAP,HR,SPO2 and blood-gas in different times. Results The time,from finishing operation to conscious recovery state,was（ 13.53 ± 3.72） min in the group A and（34.47 ± 7.46） min in the group B. There were statistical significance in MAP and HR value between group A and B during the anesthesia period（P 〈 0.05 ）. There was no statistical difference in MAP and HR value in the group A （P 〉 0.05 ）, but was in the group B （P 〈 0.05） compared to basic data. There was no statistical significance in SPO2 and RR value between group A and B（ P 〉 0.05 ）. Conclusion In the group A, haemodynamic was in steady state during operation and no statistical difference in contrast with basic data and pain state was deleted entirely. The time, from finishing operation to conscious recovery state in the group A, was obviously shorter than that in the group B. The effect of anesthesia in the group A was remarkably better than that in the group B.