不同剂量氯胺酮对七氟烷麻醉下小儿分离焦虑及苏醒期躁动的影响

Effect of different doses of ketamine on separation anxiety and emergence agitation in pediatrics undergoing PCNL under sevoflurane general anesthesia

目的：探讨不同剂量氯胺酮对七氟烷麻醉下小儿分离焦虑及苏醒期躁动（Emergenceagita—tion，EA）的影响。方法：80名择期行经皮肾镜钬激光碎石术（PCNL）的2～8岁小儿随机分为4组：C组给予生理盐水，K0．5、K0．75、K1组分别在小儿入室前静注氯胺酮0．5、0．75、1mg／kg，4组患儿均接受常规七氟烷维持麻醉。评估各组小儿麻醉诱导前分离焦虑评分，记录小儿的拔管时间、麻醉后监测治疗室（PACU）停留时间、术后恶心呕吐、EA发生率及修正CHEOPS疼痛评分。结果：K0．75、K1组患儿术前分离焦虑评分明显低于K0．5组及C组（P〈O．05），K1组拔管时间及PACU停留时间明显长于其他3组（P〈0．05），C组EA发生率和CHEOPS评分明显高于3个氯胺酮组（P〈0．05），但3个氯胺酮组间差异无统计学意义（P〉0．05）。结论：0．75mg／kg氯胺酮入室前静注能减少小儿分离焦虑评分、术后疼痛评分及EA发生，且不影响拔管时间及PACU停留时间。

AIM ： To tive effect of ketamine investigate the preven- with different doses onseparation anxiety and emergence agitation （EA） after sevoflurane anesthesia in children for PC-NL （percutaneous nephrolithotomy lithotripsy） surgery. METHODS. Eighty children, ranging in age from 2-8 years old, undergoing PCNL surgery were randomly allocated to one of the 4 groups： group C received normal saline, group K 0.5, K 0.75 and K1 received ketamine 0.5 mg/kg, 0.75 mg/kg or 1.0 mg/kg intravenously before entering the operating room respectively. Children in four groups received conventional sevoflurane for maintain anesthesia. The separa- tion anxiety score before induction was evalua- ted. Extubation time, post-anesthesia care unit stay time, postoperative nausea and vomiting, e- mergence agitation, and pain （the modified Chil- dren＇s Hospital of Eastern Ontario Pain Scale, Modified CHEOPS） were assessed. RESULTS： The preoperative separation anxiety scores in group K 0.75 and group K1 were significantlylower than those in group K 0.5 and group C（P 〈0.05）. Time of extubation and post-anesthe- sia care unit stay in group K1 was significantly lower than that three groups（P〈0.05）. The in- cidence of EA and Modified CHEOPS were sig- nificantly higher than those three-ketamine groups（P〈0.05） ,but there was no statistically significant differences among three ketamine groups （ P 〈 0.05 ）. CONCLUSION： Ketamine 0.75 mg/kg administered before entering the op- erating room reduced separation anxiety, post- operative pain and incidence of EA without delay in recovery.