小剂量氯胺酮丙泊酚全麻和利多卡因腹膜表面麻醉在小儿阑尾切除术中的应用

Application of small dose ketamine propofol general anesthesia combined with lidocaine peritoneal surface anesthesia in pediatric appendectomy

目的比较小剂量氯胺酮丙泊酚复合全麻辅以利多卡因切口下腹膜表面麻醉,与氯胺酮丙泊酚复合全麻,在小儿阑尾切除术中的临床效果和不良反应。方法选小儿阑尾切除术46例,ASA I或II级,随机分为2组,AS组:采用小剂量氯胺酮(1 mg/kg)丙泊酚复合全麻辅以1%利多卡因3～5 ml切口下腹膜表面麻醉26例;A组:采用氯胺酮丙泊酚复合全麻20例。观察2种麻醉方法的生命体征的改变,手术时患儿的反应以及患儿全麻苏醒情况。结果AS组与A组比较,AS组具有较好的生命体征稳定性,腹膜松弛明显,牵拉反应小,苏醒快,恶心呕吐反应少。结论小剂量氯胺酮丙泊酚全麻和利多卡因腹膜表面麻醉在小儿阑尾切除术中应用起到良好的镇痛、镇静,满意的切口下的腹膜松弛,能有效地抑制探查牵拉阑尾时内脏牵拉反应和鼓肠屏气反应,使得呼吸循环趋于稳定,降低术后切口皮肤疼痛及切口下腹膜缝合后产生的张力性刺激牵拉痛与不适,患儿苏醒快。

Objective To study the application of small dose ketamine propofol general anesthesia combined with lidocaine peritoneal surface under incision anesthesia, and ketamine propofol compound anesthesia for pediatric appendectomy, and com- pare their clinical effects and adverse reactions. Methods 46 cases receiving peritoneal surface anesthesia （ ASA class I or II） were chosen and randomly divided into two groups （ group AS, n = 26 ; group A, n = 20 ）. Group AS was treated with small dose ketamine propofol general anesthesia combined with lidocaine （ 1% ） 3 - 5 ml peritoneal surface under incision anesthesia. Group A underwent ketamine propofol compound anesthesia. The two anesthesia methods were observed in terms of the changes in vital life signs, the patients＇reaction during the operation and the general situation of analepsia. Results Compared with group A, group AS showed stability in life signs, obvious peritoneal relaxation, less traction reaction, fast analepsia and less nausea and vomiting. Conclusion Small dose ketamine propofol general anesthesia combined with lidocaine peritoneal surface anesthesia for pediatric appendectomy demonstrates good analgesic and calm effect. The under-incision peritoneal relaxation is satisfactory. It can effectively restrain the visceral traction reaction and the intestinal tympanites reaction,ensure stable respira- tion, reduce skin incision pain and tension induced discomfort caused by the peritoneal suture. Patients regain consciousness fast.