硬膜外神经阻滞复合氯胺酮麻醉在小儿阑尾手术中的应用

Application of Epidural Nerve Block Combined with Ketamine Anesthesia in Pediatric Appendicitis Operation

目的观察罗哌卡因硬膜外阻滞复合氯胺酮-丙泊酚静脉麻醉在小儿阑尾手术中的应用,对呼吸循环功能以及术后恢复情况的影响。方法 60例行阑尾手术患儿随机分为两组:氯胺酮基础麻醉后,硬膜外神经阻滞复合氯胺酮-丙泊酚静脉麻醉组(A组,n=30),硬膜外穿刺成功后注入0.375%罗哌卡因0.2mL/kg,术中以氯胺酮一丙泊酚持续静注;另一组氯胺酮基础麻醉后,单纯氯胺酮-丙泊酚静脉麻醉组(B组,n=30),术中氯胺酮一丙泊酚持续静注。结果术中A组循环,呼吸功能较B组稳定(P<0.05),肢体不良自主运动,喉痉挛等不良反应较B组少(P<0.05),A组氯胺酮用量明显少于B组(P<0.01),术后A组苏醒较快且平稳,恢复期精神症状少,与B组比较有显著差异(P<0.05)。结论硬膜外神经阻滞复合氯胺酮-丙泊酚静脉麻醉应用于小儿阑尾手术,可减少氯胺酮用量从而减少其不良反应,使患儿在麻醉手术期间呼吸循环更平稳,外科医师更满意,在小儿麻醉中是一种值得推广的麻醉方法。

Objeetive To observe the effect of ropivacaine epidural anesthesia combined with ketamine and propofol intravenous anesthesia used in pediatric appendicitis operation and the effect on the recovery of respiratory and circulatory function and postoperative. Methods 60 cases of appendix operations were randomly divided into two groups： ketamine basic anesthesia, epidural nerve block combined with ketamine and propofol intravenous anesthesia group （group A, n=30）, epidural puncture success after injection of 0.375% ropivacaine 0.2mL/kg, intraoperative ketamine-propofol continuous infusion; another group of ketamine after basal anesthesia, ketamine and propofol intravenous anesthesia group （group B, n=30）, intraoperative ketamine-propofol continuous infusion. Results The patients in group A than in group B stable circulatory and respiratory function （P〈0.05）, limb adverse independent movement, laryngeal spasm and other adverse reactions less than that of B group （P〈0.05）, group A ketamine dosage was less than B group （P〈0.01）, a postoperative group recovery quickly and smoothly, the recovery period of psychiatric symptoms significantly less, compared with group B （P〈0.05）. Epidural nerve block combined with ketamine and propofol intravenous anesthesia in pediatric appendicitis operation, can reduce the dosage of ketamine, thereby reducing the adverse reaction, make the patients during anesthesia and operation in respiratory cycle is more stable, the surgeon satisfaction, is a worthy of anesthesia in pediatric anesthesia. Conclusion Epidural nerve block combined with ketamine and propofol intravenous anesthesia in pediatric appendicitis operation, can reduce the dosage of ketamine, thereby reducing the adverse reaction, make the patients during anesthesia and operation in respiratory cycle is more stable, the surgeon satisfaction, is a worthy of anesthesia in pediatric anesthesia.