臂丛神经阻滞复合氯胺酮静脉麻醉在小儿上肢手术中的探讨

Brachial plexus block combined with ketamine intravenous anesthesia in pediatric surgery of upper extremity

目的观察利用周围神经刺激器辅助定位,罗比卡因臂丛神经阻滞复合氯胺酮静脉麻醉在小儿上肢手术中应用,对呼吸循环功能以及术后恢复情况的影响。方法30例行上肢手术患儿随机分为两组:臂丛神经阻滞复合氯胺酮静脉麻醉组(A组),氯胺酮基础麻醉后,应用神经刺激器辅助定位臂丛阻滞成功后注入0.25%罗比卡因0.5ml/kg;单纯氯胺酮静脉麻醉组(B组),术中氯胺酮1～2mg/(kg.h)间断静脉注射。结果术中A组循环、呼吸功能较B组稳定;肢体不良自主运动,喉痉挛等不良反应较B组少,A组氯胺酮用量明显少于B组;术后A组苏醒较快且平稳,恢复期精神症状少,与B组比有显著差异。结论臂丛神经阻滞复合氯胺酮静脉麻醉应用于小儿上肢手术,可减少氯胺酮用量从而减少其不良反应,使患儿在麻醉手术期间呼吸循环更平稳,家长及医护人员满意度明显提高。

Objective To observe the use of peripheral nerve stimulator-assisted positioning, ropiva- caine brachial plexus block combined with ketamine intravenous anesthesia in pediatric upper extremity surgery applications, pairs of respiratory and circulatory functions and postoperative recovery situation. Methods 30 routine upper extremity surgery were randomly divided into two groups：brachial plexus block combined with ket- amine intravenous anesthesia group （A group）, ketamine-based anesthesia, application of nerve stimulator-assis- ted positioning brachial plexus block injected 0. 25% after the success of Romania than Cain 0. 5 ml/kg; pure ketamine intravenous anesthesia group （B group）, intraoperative ketamine 1 ~ 2 mg/（ kg ~ h）intermittent intra- venous injection. Results A group of cycles in the results of surgery, respiratory function compared with B group stability; body negative self-movement, laryngeal spasm fewer adverse reactions than the B group, A group of ketamine dosage was less than B ; after A group of awake faster and stable recovery period of fewer psychiatric symptoms, compared with the B group were significantly different. Conclusion brachial plexus block combined with ketamine intravenous anesthesia for pediatric upper extremity surgery, can reduce the dosage of ketamine to reduce their adverse reactions to anesthesia in children with more stable during the respiratory and circulatory, parents and staff satisfaction has improved significantly.