阴茎背神经阻滞用于小儿包皮环扎术的临床观察

Clinical observation of penile dorsal neurotomy on circumcision in children

目的观察七氟醚吸入复合小剂量氯胺酮静注联合罗哌卡因阴茎背神经阻滞在小儿包皮环扎术的麻醉效果。方法选取2012年1月至2013年12月在广东省佛山市顺德妇幼保健院择期行包皮环扎术患儿50例,随机分为实验组和对照组,每组各25例。实验组患儿在吸入七氟醚复合静注氯胺酮的基础上选择罗哌卡因行阴茎背神经阻滞,对照组患儿仅在吸入七氟醚复合静注氯胺酮下完成手术,比较两组患儿在手术期的各项重要指标:不同时间点的平均动脉压、心率、血氧饱和度、氯胺酮用量、苏醒时间及苏醒期间躁动情况。结果手术开始后10min,实验组平均动脉压及心率均比对照组平稳(t值分别为3.452和4.418,均P<0.05);实验组氯胺酮用量为(40±12)mg,少于对照组的(70±15)mg(t=7.812,P<0.05);实验组苏醒时间为(6±4)min,短于对照组的(15±6)min(t=3.753,P<0.05);实验组苏醒期间有4例疼痛躁动,少于对照组的15例(t=6.472,P<0.05)。结论应用七氟醚吸入复合小剂量氯胺酮静注联合罗哌卡因阴茎背神经阻滞的技术为小儿包皮环扎术提供了一种更为安全、有效、满意的麻醉方法。

Objective To observe the anesthetic effect of composite treatment of inhalational sevoflurane and small dose intravenous ketamine combined with ropivacaine-used penile dorsal neurotomy on circumcision in children. Methods Fifty children, who underwent circumcision in Shunde Maternity and Child Health Hospital of Foshan from January 2012 to December 2013, were selected and evenly divided into two groups. Test group was given inhalational sevoflurane and small dose intravenous ketamine combined with ropivacaine-used penile dorsal neurotomy, while control group was merely given inhalational sevoflurane and small dose intravenous ketamine. Important indexes of two groups were compared and analyzed, including mean arterial pressure, heart rate, blood oxygen saturation, dosage of ketamine, awaking time and the numbers of children having restlessness in awaking stage. Results Compared with the control group, the test group had more stable mean arterial pressure and heart rate （t value was 3. 452 and 4. 418, respectively, both P 〈 0.05 ）. The dosage of ketamine in the test group was 40 ± 12 mg, which was significantly less than that in the control group （70 ± 15 rag） （t =7. 812,P 〈 0.05）. The awaking time of the test group was 6 ± 4 rain, which was significantly less than that of the control group （ 15 ± 6 rain） （ t = 3. 753, P 〈0.05 ）. In awaking stage, there were 4 children having restlessness in the test group, while in the control group there were 15 cases （t = 6. 472, P 〈 0.05 ）. Conclusion The composite treatment of inhalational sevoflurane and small dose intravenous ketamine combined with ropivaeaine-used penile dorsal neurotomy provides a more safe, effective and satisfactory method of anesthesia for circumcision in children.