婴幼儿手外科手术的麻醉处理

Anesthesia for Hand Surgery in Infants

目的观察氯胺酮基础麻醉下施行腋路臂丛麻醉在婴幼儿手外科手术中的临床效果。方法选择婴幼儿手外科手术30例,入手术室后均肌注氯胺酮4～6 mg/Kg,待患儿入睡后行腋路臂丛麻醉,局麻药罗哌卡因浓度为0.15%,用量为1.5～2 mg/Kg,注药容量为0.8 mL/Kg。观察并记录术中麻醉效果及RR、HR、SpO2等的变化。结果全组患儿中,臂丛麻醉效果优25例,良3例,优良率达93.3%(其中有3例因上臂应用止血带,在手术开始2 h后出现肢动反应,后给予静注氯胺酮1～4次,顺利完成手术);差为2例(手术开始即需静注氯胺酮,静脉追加氯胺酮2～5次完成手术)。所有患儿术后恢复情况良好,均无麻醉并发症出现。结论在氯胺酮基础麻醉下施行腋路臂丛麻醉用于婴幼儿手外科手术,麻醉效果满意、操作方便、安全实用。

Objective To observe the clinical effect of axillary brachial plexus anesthesia in infants with ketamine basal anesthesia for hand surgery in infants.Methods A total of 30 children were included in this study.They were anesthetized with ketamine by intramuscular administration,at a dosage of 4-6 mg/Kg in the operating room.After falling asleep,they underwent axillary brachial plexus block using 0.15% ropivacaine.The dosage was 1.5-2 mg/Kg and injecting capacity was 0.8 mL/Kg.The anesthetic effect and RR,HR,SpO2 changes were observed and recorded.Results All the patients were followed and 25 cases got the excellent result,3 cases got the good result,the excellent and good rate was 93.3%（3 cases using upper arm tourniquet had limb movement 2 hours after operation started,were given ketamine intravenously 1-4 times to complete the surgery）.Two cases got the bad results,intravenous ketamine was required when the surgery started and additional 2-5 times of ketamine was given to complete the surgery.All patients recovered well after surgery without anesthetic complications.Conclusion Axillary brachial plexus anesthesia with ketamine basal anesthesia in the hand surgery of infants provides satisfactory effects and is a easy,safe technique.