异丙酚复合氯胺酮恒速静脉注射在小儿麻醉中的剂量研究

Optimal Proportion of Propofol-Ketamine Mixture for Pediatric Anesthesia by Intravenous Injection at Constant Velocity

目的探讨异丙酚复合氯胺酮不同配比恒速静脉注射在小儿麻醉中的应用。方法 60例择期手术患儿按随机数字表法分为3组,每组20例,以3种不同配比的氯胺酮和异丙酚进行恒速静脉注射维持麻醉:Ⅰ组氯胺酮37.5μg.kg-1.min-1和异丙酚25μg.kg-1.min-1;Ⅱ组氯胺酮37.5μg.kg-1.min-1和异丙酚37.5μg.kg-1.min-1;Ⅲ组氯胺酮37.5μg.kg-.min-1和异丙酚50μg.kg-.min-1,手术结束前5 min停药,术中保留自主呼吸,面罩吸氧,观察在不同的时间点平均动脉血压(MAP)、心率(HR)、血氧饱和度(SpO2)、呼吸频率(RR)变化以、苏醒时间及并发症的发生率,找出最佳的配比组合。结果Ⅰ组各时间点MAP、HR同术前比有统计学意义(P<0.05),Ⅱ、Ⅲ组HR和MAP较稳定,同术前比较差异无统计学意义(P>0.05);3组RR和SpO2间比较,差异无统计学意义(P>0.05);苏醒时间Ⅰ组较Ⅱ、Ⅲ组长,Ⅲ组并发症、术中追加药物次数最少(均P<0.05)。结论静脉注射维持麻醉时氯胺酮37.5μg.kg-1.min-1和异丙酚50μg.kg-1.min-1为最佳配比组合。

Objective To evaluate the intravenous injection of different ratios of propofol and ketamine at constant velocity during pediatric anesthesia.Methods Three different ratios of ketamine and propofol were intravenously injected at constant velocity to induce and maintain anesthesia in 60 patients undergoing elective surgery.The patients were randomly divided into three groups：GroupⅠ（ketamine 37.5 μg·kg-1·min-1,propofol 25 μg·kg-1·min-1）,Group Ⅱ（ketamine 37.5 μg·kg-1·min-1,propofol 37.5 μg·kg-1·min-1）,and Group Ⅲ（ketamine 37.5 μg·kg-1·min-1,propofol 50 μg·kg-1·min-1）,with 20 patients in each group.Drugs were discontinued 5 minutes before the end of surgery in all patients who maintained spontaneous breathing and received oxygen through face masks.Changes in mean arterial pressure（MAP）,heart rate（HR）,respiratory rate（RR） and oxygen saturation（SpO2） and the incidence of complications were observed at different time points to find the optimal proportion of propofol-ketamine mixture.Results In the postoperative evaluation,MAP and HR at different time points in GroupⅠ were higher than preoperatively（P0.05）,but MAP and HR in Group Ⅱ and Ⅲ were not altered obviously（P0.05）.There were no significant differences in RR and SpO2 among the three groups（P0.05）.Compared with Group Ⅰ,the recovery time significantly decreased in Group Ⅱ and Ⅲ,and the least complications and the number of giving intra-operatively additional drugs were observed in Group Ⅲ（P0.05）.Conclusion Ketamine（37.5 μg·kg-1·min-1） and propofol（50 μg·kg-1·min-1） is optimal proportion for pediatric anesthesia.