氯胺酮不同配伍用于小儿麻醉对血流动力学及应激反应影响的比较

Comparison of the Effect of Different Combinations of Ketamine on Hemodynamics and Stress Response in Pediatric Anesthesia

目的:比较氯胺酮复合不同的镇静麻醉药全凭静脉麻醉用于小儿手术对血流动力学、血糖及皮质醇的影响,为氯胺酮在小儿麻醉中合理联合用药提供理论依据。方法:选择60例体表手术患儿,ASAⅠ～Ⅱ级,年龄2～8岁,随机分为氯胺酮加咪唑安定组(KM组)和氯胺酮加丙泊酚组(KP组),每组各30例。术中观察两组收缩压(SBP)、舒张压(DBP)、心率(HR)、sPO2、血清皮质醇、血糖的变化,并记录苏醒时间、苏醒期状况及术后行为改变。结果:两种方法均能满足手术要求,麻醉期间KP组血流动力学明显较KM组稳定(P<0.01);两组在诱导后血糖均升高,但各时点KM组均高于KP组(P<0.05);与术前相比,KM组在诱导后和手术开始30min皮质醇差异有统计学意义(P<0.01),KP组各时点皮质醇无明显变化(P>0.05),但两组间比较各时点KM组皮质醇均高于KP组(P<0.05);苏醒时间以KP组快,组间比较差异有统计学意义(P<0.01)。结论:氯胺酮与丙泊酚联合使用,血流动力学稳定,可有效降低应激引起的内分泌和代谢反应。术后苏醒快,不良反应发生率低,用于小儿手术麻醉中具有明显的优越性。

Objective：Comparison the influences of the ketamine combined with different narcotic in total intravenous anesthesia for pediatric surgery on hemodynamics,blood glucose and cortisol,and provide theoretical base on reasonable drug combination in pediatric anesthesia.Methods：60 cases of superficial surgical children,ASA Ⅰ～Ⅱ grade,aged 2～8 years old,were randomly divided into two groups：ketamine combined with midazolam group（KM group,30 cases）,ketamine combined with propofol group（KP group,30 cases）.Observed SBP,DBP,HR,sPO2,serum corticosteroid,blood glucose changes,and record the awake time,recovery period and postoperative behavioral changes status.Results：Two methods are both satisfied with the operation,haemodynamics in KP group is obviously stable compare with that in KM group during anesthesia（P0.01）.Two groups in blood glucose were increased after the induction,but the point KM were higher than KP group（P0.05）.Compared with the preoperative,KM group differences in cortisol were significantly at the induction and 30min after surgery began（P0.01）,and KP group had no significant change in cortisol at each time point（P0.05）,but at each time point between two groups of cortisol KM group were higher than the KP group（P0.05）.Recovery time of KP group was quick,the difference between the two groups was significant（P0.01）.Conclusion：Ketamine combine with propofol has a stabile hemodynamic,can effectively reduce the stress caused by endocrine and metabolic responses.Faster postoperative recovery,lower incidence of adverse reactions,for pediatric anesthesia has obvious advantages.