艾司洛尔应用于婴幼儿氯胺酮麻醉中的临床观察

Clinical Observation of Esmolol Ketamine Anesthesia Used in Infants and Young Children

目的:观察艾司洛尔在婴幼儿眼科手术氯胺酮麻醉中的降心率作用。方法:年龄1～12个月拟行青光眼或白内障常规手术患儿160例,随机分为两组:观察组83例,对照组77例。两组患儿术前30min均肌注阿托品0.02mg/kg,入室后开放静脉,以每小时5ml/kg速度输注乳酸钠林格溶液,静脉注射氯胺酮2mg/kg诱导,术中以每小时2.5mg/kg持续微量泵入氯胺酮维持麻醉。观察组在麻醉诱导前即刻静脉注射艾司洛尔0.5mg/kg,然后以每分钟0.1mg/kg泵注维持;对照组用等量乳酸钠林格溶液泵注,持续监测SPO_2、HR、RR,并记录入室前(T_0)、入室后(T_1)、诱导前(T_2)、诱导后1 min(T_3)、诱导后2min(T_4),诱导后5min(T_5),术前1min(T_6),术中(T_7),术毕即刻(T_8)不同时间点的HR。结果:对照组在静脉注射氯胺酮后,T_3、T_4、T_5、T_6、T_7、T_8的HR比基础值T0显著增加(P<0.05);观察组T_3、T_4、T_5、T_6、T_7、T_8较T_0无显著变化(P>0.05)。结论:复合应用艾司洛尔可有效的控制氯胺酮引起的心率增快的副作用,维持了氯胺酮麻醉患儿的循环稳定。

Objective： Esmolol observed in infants ketamine anesthesia in ophthalmic surgery reduced heart rate effects. Methods： Aged 12 months to be a line of conventional glaucoma or cataract surgery in children with 160 cases were randomly divided into two groups： the observation group 83 patients, 77 patients with the control group. Two groups of children were intramuscularly 30rain preoperative atropine 0.02mg/kg, burglary, after an open vein, 5ml/kg hour infusion of lactated Ringer solution speed, intravenous injection of ketamine 2mg/kg induction, intraoperative per hour 2.5mg/kg continuous infusion of ketamine to maintain anesthesia trace. Observation group immediately before induction of anesthesia, intravenous esmolol 0.5mg/kg, and 0.1 mg/kg per minute infusion maintained; control group with equal lactated Ringer solution infusion, Continuous monitoring of SPOt, HR, RR, and record the break-before （T0）, burglary after （T1）, before induction （T2）, induced by 1 rain （T3）, induced by 2 min （T4）, induced by 5min （T5）, preoperative I min （T6）, surgery （T7）, operation completed immediately （Ts） at different time points of the HR. Results： The control group, after intravenous injection of ketamine, T3, T4, T5, T6, T7, T8 than the base value TO of the HR increased significantly （P〈0.05）; the observation group T3, T4, T5, T6, T7, T8 compared with To was no significant change （P〉0.05）. Conclusions： Esmolol composite applications can be effectively controlled by ketamine fast heart rate caused by side effects, maintain the stability of the cycle of ketamine anesthesia in children.