氯胺酮复合异丙酚麻醉在小儿疝高位结扎术中的应用

Clinical observation of combine Ketamine and Propofol in pediatric inguinal hernia high ligation

目的观察氯胺酮复合异丙酚麻醉在小儿疝高位结扎术中的应用。方法拟行疝高位结扎术患儿60例,按随机数字表分成3组,Ⅰ组患者麻醉诱导予氯胺酮2mg/kg缓慢静脉注射,术中间断静注氯胺酮1mg/kg维持麻醉;Ⅱ组患儿先予氯胺酮和异丙酚各2mg/kg诱导,麻醉维持予异丙酚8mg/(kg·h)连续泵注;Ⅲ组患者麻醉诱导用芬太尼1μg/kg,异丙酚2mg/kg,麻醉维持以异丙酚8mg/(kg·h)连续泵注。观察3组患者在麻醉前(T0),诱导后(T1),手术时(T2)以及术毕(T3)时的HR、MAP、SpO2以及苏醒时间和不良反应发生情况。结果Ⅰ组患者HR、MAP在T1、T2、T3时间点均较T0明显上升(P<0.05),Ⅲ组HR、MAP、SpO2在T1时间点较T0明显下降(P<0.05),Ⅱ组各参数于T1、T2、T3与T0比较均差异无统计学意义。Ⅲ组呼吸抑制和呛咳明显(P<0.05),Ⅰ组惊厥明显(P<0.05)。结论氯胺酮复合异丙酚静脉麻醉能提供较完善的镇静镇痛,可安全有效地应用于小儿疝手术。

Objective To evaluate the effect of combine Ketamine and Propofol in pediatric inguinal hernia high ligation. Methords Sixty children scheduled for pediatric inguinal hernia high ligation were divided into three groups： group Ⅰ was injected intravenously with Ketamine 2 mg/kg for inducing, and anesthesia was maintained with Ketamine 1 mg/kg inter- rnptedly; group Ⅱ was inducted with Ketamine 2 mg/kg and Propofol 2 mg/kg, anesthesia was maintained with Propofol 8 mg/（kg.h） infusion; group Ⅲ was inducted with fentanyl 1 μg/kg and Propofol 2 mg/kg, maintained with Propofol 8mg/ （kg· h） infusion. Mean arterial pressure （MAP）, heart rate （HR）, pulse oxygen saturation （SpO2） were recorded before anes thesia （TO）, after induction （T1）, during operation （T2）, after operation （T3）, the average awakening time after operation and side-effects were observed. Results HR, MAP in group I ascend significantly at T1, T2, T3 compared with TO; HR, MAP, SpO2 in group m decreased significantly at T1 compared with TO; HR, MAP, SpO2 in group Ⅱ did not show obvious differ ences between T0-T3, the awakening time in group Ⅱ and group m was shorter than group I obviously, the rate of respira- tory inhibition was higher in group Ⅲ compared with group I and group Ⅱ, convulsion in group I was obviously. Conclu sion Based on perfect effects of sedation and analgesia, Ketamine combined with Propofol anesthesia can be used in pedi atric inguinal hernia high ligation .