瑞芬太尼与芬太尼用于小儿氯胺酮麻醉效果比较

A comparison on the effects of remifentanil and fentanyl combined with ketamine infusion in paediatric anesthesia

目的比较瑞芬太尼与芬太尼用于小儿氯胺酮的麻醉效果。方法 90例ASAⅠ～Ⅱ级患儿随机分为三组,各30例,即瑞芬太尼复合氯胺酮组(RK)、芬太尼复合氯胺酮组(FK)及氯胺酮组(K)。观察记录患儿给药前、手术5min、15 min及术毕时血压(SBP)、心率(HR)、呼吸(RR)及血氧饱和度(SpO2)、术中氯胺酮用量、术后苏醒时间,术中、术后不良反应等。结果麻醉后5 min、15 min及术毕时SBP、HR值与麻醉前相比,RK组无显著性差异(P>0.05),FK、K组显著高于麻醉前水平(P<0.05),组间比较有显著性差异(P<0.05),K组HR显著高于FK组(P<0.05);RK组术中、术后低氧血症、呼吸抑制、呼吸道分泌物、体动、烦躁均少于FK组与K组(P<0.05)。三组患儿术后苏醒时间及氯胺酮用量,RK组显著少于FK、K组,FK组显著少于K组(P<0.05)。结论瑞芬太尼复合氯胺酮麻醉术中血流动力学稳定、镇痛完全、并发症及用药量均减少、苏醒时间短,效果优于芬太尼与氯胺酮复合麻醉。

Objective To compare the effects of remifentanil and fentanyl combined with ketamine infusion in paediatric anesthesia. Methods Ninety pediatric patients were randomly divided into 3 groups： group [ remifentanil＋ketamine （RK）, group Ⅱfentanyl＋ketamine （FK） and group m ketamine （K）. Systolic blood pressure （SBP）, heart rate （HR）, pulse oxygen saturation （SpO2） and respiratory rate （RR）, total amount of ketamine, recovery time and perioperative untoward reaction et al were observed and recorded at pre-operation, 5 rain and 15 min after surgery and the end of surgery, respectively. Re sults Intragroup comparison, at 5 rain and 15 rain after anesthesia and the end of surgery vs pre-anesthesia, SBP and HR were no difference in group RK （P 〉 0.05）, were elevated in group FK and K （P 〈 0.05）. Compared with group RK, total amount of ketamine, recovery time and perioperative untoward reaction （such as postoperative hypoxemia, respiratory depression and secretions and emergence delirium et al） were lower than those in the group FK and K （P 〈 0.05）. Conclusion Of remifentanil combined with ketamine anesthesia, intraoperative hemodynamic stability, analgesia, complications and drug consumption are reduced, recovery time is short, effect is better than that of ketamine and fentanvl anesthesia.