氯胺酮肌肉注射与面罩下吸入七氟醚两种麻醉方式在小儿麻醉手术中的临床效果及安全性比较

THE CLINICAL EFFECT AND SAFETY OF MASK INHALATION OF SEVOFLURANE OPERATION AND KETAMINE INTRAMUSCULAR INJECTION IN PEDIATRIC ANESTHESIA

目的 将面罩下吸入七氟醚应用于小儿麻醉手术的临床效果及安全性与氯胺酮肌肉注射相比较,探讨其有效性、安全性。方法 选择2013年1—12月该院收治的择期手术的患儿228例,ASAⅠ~Ⅱ级,将所有患儿随机分成二组,其中氯胺酮组100例,给予氯胺酮5mg/kg肌肉注射麻醉,七氟醚组128例,给予4L/min纯氧吸入,经面罩吸入七氟醚,吸入浓度从3%逐渐增加至8%。在手术前后对患儿心率（HR）、平均动脉压（MAP）、动脉血氧饱和度（SPO2）进行监测,采用数字分级法（NRS）对麻醉效果进行评价,观察二组患儿麻醉诱导时间、苏醒时间、手术时间、麻醉费用及不良反应发生情况。结果 二组患儿麻醉效果、手术时间、麻醉费用差异无统计学意义（t=0.38、0.77、0.31,P〉0.05）,七氟醚组麻醉诱导时间、苏醒时间显著短于氯胺酮组,二组差异有统计学意义（t=55.43、30.42,P〈0.05）;二组患儿在插管前后HR、MAP、SPO2平稳,二组差异无统计学意义（P〉0.05）;二组不良反应差异有统计学意义（P〈0.05）。结论 面罩下吸入七氟醚应用于小儿麻醉手术较氯胺酮肌肉注射效果显著,其具有起效快、苏醒时间短、患儿易于接受、不良反应小等优点,为小儿麻醉诱导的理想药物。

Objective To explore the effectiveness and safety of mask inhalation of sevoflurane and ketamine intra- muscular injection in pediatric anesthesia. Methods Totally 228 cases, ASA I- II patients from January 2013 to December 2013 in author＇s hospital were selected, all patients were randomly divided into two groups, ketamine group had 100 cases, whom were given 5mg/kg intramuscular injection of ketamine anesthesia, sevoflurane group had 128 cases, whom were given 4L/min pure oxygen inhalation, sevoflurane inhalation via mask, concentration from 3% gradually increase to 8%. The heart rate （HR）, mean arterial pressure （MAP）, arterial oxygen satura- tion （SPO2） monitoring before and after the operation, the NRS were used to evaluate the effects of anesthesia, two groups of children anesthesia induction time, recovery time, operation time, the cost of anesthesia and the incidence of adverse reactions were observed. Results The anesthetic effect, operation time, the cost of anesthesia of the two groups had no significant difference （t = 0. 38, 0.77, 0.31,P〉0.05）, sevoflurane anesthesia induction time, recovery time was significantly shorter in the ketamine group, there was significant difference between two groups （t= 55.43, 30. 42,P〈0.05）; HR MAP, SPO2 of two groups children had no significance statistical difference before and after tracheal intubation （P〉0.05） ; Adverse reaction of the two groups had statistically sig- nificant difference（P〈0.05）. Conclusion The effect of mask inhalation of sevoflurane anesthesia with ketamine in pediatricoperation intramuscular injection is obvious, it has a rapid onset, recovery time is short, easy to accept and little adverse reaction, it is worth in pediatric anesthesia used in the operation.