硬膜外阻滞复合异丙酚镇静在复杂型小儿尿道下裂手术中的应用

Application of epidural block combined with propofol sedation in the surgery for complex hypospadia in children

目的:探讨硬膜外阻滞复合异丙酚镇静麻醉用于小儿尿道下裂手术的临床实用性和安全性。方法:40例尿道下裂患儿随机分为氯胺酮麻醉组(KA组,n=20)和硬膜外阻滞复合异丙酚组(EP组,n=20),记录两组手术时间、氯胺酮的用量。观察两组术前,切皮时,苏醒时的心率,平均动脉压变化程度以及术后意识恢复,镇痛效果,不良反应的发生率。结果:在手术时间较长的复杂型小儿尿道下裂手术中两组相比较,EP组氯胺酮用量少,异丙酚用量合适,呼吸循环稳定,术后清醒快,镇痛效果好。结论:硬膜外阻滞复合异丙酚麻醉用于手术时间较长的复杂型小儿尿道下裂手术,安全,临床效果满意,优于氯胺酮麻醉。

Objective To explore the practicability and safety of epidural block combined with propofol sedation in the operation for complex hypospadia in children. Methods Forty children with complex hypospadia were randomly divided into 2 groups. Children in KA group received intravenous injection of ketamine （n = 20） and those in EP group was given epidural block combined with propofol（n = 20）. The operation time and dose of ketamine of the two groups were recorded respectively. The variation of HR and MAP during preoperation, skin incision, and analepsia after operation were recorded, and the analgesia effect, side effect, and recovery time after the operation were observed. Result In the operation of complex hypospadia in children, the dose of ketamine in EP group was less than that in KA group. The vital sign was more stabilized and children could be waken up more quickly with less pain in the EP group. Conclusion Epidural block combined with propofol is safe and effective in the operation of complex hypospadia in children than ketamine.