亚麻醉剂量氯胺酮-芬太尼辅助区域麻醉的应用

Application of sub-anesthetic doses of ketamine and fentanyl assisted regional anaesthesia

目的观察亚麻醉剂量的氯胺酮-芬太尼辅助区域麻醉的临床效果及安全性。方法选取各类需要择期进行腹部或者四肢手术的患儿90例，并将其按随机数字表法分为A、B、C三组，各30例。A组采用亚麻醉剂量氯胺酮-芬太尼辅助神经阻滞麻醉；B组采用亚麻醉剂量氯胺酮-芬太尼辅助椎管内麻醉；C组采用传统剂量氯胺酮麻醉。对三组患儿呼吸频率、平均动脉压、心率以及血氧饱和度等基本生命体征以及麻醉不良反应发生情况进行比较。结果A组和B组患儿呼吸频率、平均动脉压以及心率均显著低于C组（均P〈0．05），而三组患儿血氧饱和度差异无统计学意义（P〉0．05），A组与B组患儿呼吸频率、平均动脉压以及心率差异无统计学意义（均P〉0．05）。A组、B组患儿肌松良好，没有明显体动以及胃肠道等不良反应的发生，C组肌松情况良好，但是偶有体动以及少许胃肠道不良反应的发生。结论亚麻醉剂量氯胺酮-芬太尼辅助区域麻醉具有良好的麻醉效果，而且能够有效减少不良反应的发生，值得在临床上推广应用。

Objective To observe the clinical effect and safety of subanesthetic doses of ketamine and fenta- nyl assisted regional anesthesia. Methods 90 children received abdominal operation or limbs operation were selected in our hospital. They were randomly divided into A, B and C group with 30 children in each group. The children in group A received sub-anesthetic doses of ketamine and fentanyl in nerve block anesthesia;the children in group B received sub-anesthetic doses of ketamine and fentanyl anesthesia aided ; while the children in group C accepted traditional ketamine anesthesia. The indexes of respiratory frequency, mean arterial pressure,heart rate and oxygen saturation and other basic vital signs as well as anesthesia adverse events of situation were compared. Results The respiratory frequency, mean arterial pressure and heart rate in group A and B were lower than those in group C, the difference was statistically significant（ all P 〈 0.05 ）, whereas no difference was observed on the oxygen saturation between two groups （ P 〉 0.05 ）. The respiratory rate, mean arterial pressure and heart rate in group A and B showed no significant difference （ all P 〉 0.05 ）. In adverse reactions, the muscle relaxants was in good condition in group A and B, no obvious body movement and gastrointestinal adverse events observed either. Group C with muscle relaxants in good condition, but body movement and some gastrointestinal adverse reaction can be observed occasionally. Conclusion Subanesthetic doses of ketamine and fentanyl has good anesthetic effect on regional anesthesia, and can effectively reduce the occurrence of adverse reactions,which is worthy of clinical application.