小剂量氯胺酮麻醉在小儿有创术中的应用

Application of anesthesia with low-dose ketamine in invasive operation on children

目的探讨小儿有创性穿剌和小手术前使用小剂量氯胺酮行基础麻醉达到镇痛的有效性、安全性和生物-心理-社会医学效应。方法按年龄将研究组患儿分为0～1岁组(83例)、1～3岁组(96例)、3～7岁组(56例)和7～14岁组(45例)。在操作前使用小剂量氯胺酮肌注(2mg/Kg.次)行基础麻醉。对4组患儿的麻醉起效时间和持续时间,手术前后的R、HP、BP进行观察比较。对其副作用、一次性穿剌成功率、损伤率和较大儿童(特别是白血病病人)穿剌或手术时的恐惧感、疼痛感进行调查,并与对照组0～1岁组(102例)、1～3岁组(108例)、3～7岁组(75例)和7～14岁组(59例)进行对比研究。结果①4组患儿麻醉起效时间和持续时间差异无显著性(P>0.05)。②4组患儿用药前后P、HR、BP比较,除1～3岁组舒张压差异有显著性外(P<0.05),其余差异均无显著性(P>0.05)。③研究组8例出现1～2次轻微呕吐,1例出现短暂幻觉,无一例出现呼吸抑制和呼吸道分泌物增加,与对照组比较,差异无显著性(P>0.05)。④研究组一次性穿剌成功率高(95.7%),损伤率低(7.8%),与对照组比较,差异有显著性(P<0.05)。⑤研究组儿童在对整个操作是否知情、镇痛效果和恐惧感方面与对照组比较差异有显著性(P<0.05)。结论①小剂量氯胺酮肌注行基础麻醉在小儿有创性操作和小手术中能有效地起到镇痛作用。②无明显副作用,不需在手术前使用阿托品,安全性能好。③能有效地减少穿剌损伤和提高一次性穿剌成功率。④能有效地控制有创性操作给患儿带来的恐惧和心理伤害,符合现代医学治疗模式,即生物-医学-社会交互干预的模式。

Objective To explore effectiveness,safety and effects of biology,psychology,social medicine of analgesia through basal anesthesia with low-dose ketamine in invasive puncture and before small surgery in children.Methods Disease children were divided into group of 0~1 year old（83 cases）,group of 1~3 years old（96 cases）,group of 3~7 years old（56 cases） and group of 7~14 years old（45 cases） according to age.Basal anesthesia was performed with low-dose ketamine intramuscular injection（2mg/Kg/times）.Onset time and duration of anesthesia,R,HP and BP before and after the surgery in 4 groups were observed.Side effects,one-time success rate of puncture,injury rate,and fear and pain of older children（especially children with leukaemia） were investigated and compared with that of children in groups of 0～1 year old（102 cases）,1～3 years old（108 cases）,3～7 years old（75 cases） and 7～14 years old（59 cases）.Results 1.No significant difference existed on onset time and duration of anesthesia in children among 4 groups（P〈0.05）.2.In the comparison of P,HR and BP in 4 groups before and after drug administration,no significant difference was found（P〉0.05） except that difference on diastolic pressure of group of 1 ～ 3 years old was significant（P〉0.05）.3.In study group,only 8 cases had slight vomiting,1 case short illusion and no respiratory depression or increased respiratory secretions occurred.No significance difference was found between them and that of control group（P〈0.05）.4.One-time success rate of puncture in study group was high as 95.7% and injury rate was low as 7.8% with significant difference compared with that of control group（P〈0.05）.5.Significant difference existed on awareness of whole operation,analgesic effect and fear of children between the study group and control group（P〉0.05）.Conclusion 1.Basal anesthesia with low-dose ketamine intramuscular injection played an effective analgesic role during the invasive procedure and small surgery of children.2.No obvious side effect was found and it was not necessary to use atropina before surgery with good safety.3.Puncture injury could be reduced greatly and one-time success rate of puncture could be improved effectively.4.Fear and psychological injury to children brought by invasive procedure could be control effectively and this accorded with the treatment model of modern medicine,namely biology-medicine-society interaction.