亚麻醉剂量氯胺酮-芬太尼辅助小儿区域麻醉临床效果观察

Subanesthetic Doses of Ketamine-fentanyl Assisted Regional Anesthesia in Children the Clinical Effects Observed

目的:观察亚麻醉剂量氯胺酮-芬太尼辅助小儿区域麻醉的临床效果。方法:选择我院麻醉科急诊和择期进行腹部手术和四肢手术的90例患儿,年龄3~10岁,体重15~36kg,ASAI^II级,平均分为三组,90例患儿基础麻醉均用氯胺酮(2~6mg/kg)。A组:30例患儿进行上肢手术麻醉时,先采用肌肉注射亚麻醉剂量氯胺酮(2~6mg/kg),而后辅助静脉缓慢追加小剂量芬太尼(辅助神经阻滞麻醉)。B组:30例患儿进行腹部和下肢手术时采用椎管内麻醉,麻醉药物采用亚麻醉剂量氯胺酮+芬太尼(辅助)。C组:30例患儿进行手术麻醉时,麻醉药物只是采用氯胺酮。注意记录A、B、C三组患儿的呼吸频率(RR)、平均动脉压(MAP)、心率(HR)、脉搏氧饱和度(SpO2)、氯胺酮的用量以及追加次数、芬太尼的用量、手术时间以及唤醒时间、肌肉松弛情况以及不良反应。结果:三组麻醉后,A组、B组患儿的呼吸频率、心率和脉搏氧饱和度的水平都比C组患儿低(P<0.05),并且手术中,没有发生体动、呼吸困难情况,术后没有出现恶心、呕吐等胃肠道不良反应。同时A、B组的患儿比C组患儿苏醒的时间短、手术后的氯胺酮用量也很少,A、B两组追加的次数更少,并且肌肉松弛情况和止痛的效果都良好。A、B两组较C组有显著差异(P<0.05)。结论:通过观察手术中、手术后A、B组和C组患儿的呼吸频率、心率和脉搏氧饱和度可知:亚麻醉剂量氯胺酮-芬太尼辅助小儿区域麻醉的临床效果与传统单纯氯胺酮麻醉的临床效果相比较,前者效果更好。

Objective：To observe the sub-anesthetic dose of ketamine in a pediatric regional anesthesia assisted Fentanyl clinical effect.Methods：Children with emergency surgery and elective abdominal surgery date and limb surgery of 90 cases of children aged 3~10 years old,weight： 15~36kg,ASA I^II class,were divided into three groups,90 patients suffering from ketamine-based anesthesia were children（2~6mg/kg）.Group A：30 cases of children with upper extremity surgery,anesthesia,the first use of sub-anesthetic dose of intramuscular ketamine（2~6mg/kg）,then an additional small auxiliary slow intravenous dose of fentanyl（assisted nerve block anesthesia）.Group B：30 cases of children with abdominal and lower limb surgery using spinal anesthesia,anesthetic drugs with sub-anesthetic dose of ketamine,fentanyl（secondary）.Group C：30 patients were surgical anesthesia,anesthetic drugs only with ketamine.Note that record A,B,C three groups of children with respiratory rate（RR）,mean arterial pressure（MAP）,heart rate（HR）,pulse oxygen saturation（SpO2）,ketamine,and the amount of additional number of fentanyl consumption,operation time and wake time,muscle relaxation as well as adverse reactions.Results：The three groups after anesthesia,A group,B group of children with respiratory rate,heart rate and pulse oxygen saturation level lower than group C patients（P〈0.05）,and surgery,no body movement,breathing difficulties case,no postoperative nausea,vomiting and other gastrointestinal adverse reactions.While A,B group of patients in group C patients than in waking time is short,the amount of post-operative ketamine rarely,A,B two additional times less,and muscle relaxation and analgesic effects of both good.A,B groups than the C group were significantly different（P〈0.05）.Conclusion：The observation of surgery,after surgery,A,B and C in children with respiratory rate,heart rate and pulse oxygen saturation can see：a sub-anesthetic dose of ketamine,fentanyl,supporting the clinical effects of regional anesthesia in children with traditional pure ketamine anesthesia clinical results compared to the former effect has to be better.