氯胺酮复合右美托咪定用于小儿手术麻醉的临床观察

Clinical Effect of Katamine plus Dexedetomidine in the Anesthesia of Pediatric Surgery

目的观察氯胺酮复合右美托咪定对小儿手术实施麻醉的临床效果。方法选择ASAⅠ-Ⅱ级小儿（非开颅、胸、腹）手术120例,按随机双盲法分为两组：Ⅰ组（90例）,Ⅱ组（30例）。于皮肤消毒前1min开始用药,Ⅰ组静脉注射氯胺酮3mg/kg、静脉泵注右美托咪定1μg/（kg·h）;Ⅱ组静脉注射氯胺酮3mg/kg、静脉泵注生理盐水。若术中患儿出现明显体动反应则静脉追加氯胺酮1.5mg/kg。记录氯胺酮用量、生命体征、苏醒时间及术后镇静评分,观察比较两组病例麻醉效果。结果两组病例一般资料、手术时间、手术范围等无统计学差异;Ⅰ组氯胺酮用量明显减少,术中生命体征平稳,Ⅱ组患者心率、血压在各时间段明显增高;两组苏醒时间无明显差异,Ⅰ组患儿比较安静,镇静评分满意者明显多于Ⅱ组,苏醒期躁动者明显较少。结论氯胺酮复合右美托咪定用于小儿手术麻醉效果良好,可提供较为完善的镇痛和镇静作用,明显降低单纯应用氯胺酮所致术中呼吸循环等方面的副作用以及术后躁动的发生率。

Objective To observe the clinical effect ofkatamine plus dexedetomidine in the anesthesia of pediatric surgery. Methods 120 children ofASA Ⅰ to Ⅱ （none for skull-opening, thoracic or abdominal surgery） were selected and divided into 2 groups： group Ⅰ （n= 90） and group Ⅱ （n=30）; drug administration started 1 minute before skin disinfection： intravenous injection of katamine （3mg/kg） and intravenous pumping of dexemedetomidine （1 μg/kg · h） were made to cases in group Ⅰ while intravenous of katamine （3mg/kg） and intravenous pumping of saline were made to cases in group Ⅱ; katamine （3mg/kg） was added to cases in both groups if body movement response was observed; dosage of total katamine, vital signs, recovery time and postoperative sedation scores were recorded and the anesthetic effects in the 2 groups were compared. Results There existed no statistic difference in the general data, operation time and operation scope between the 2 groups; the dosage of katamine in group Ⅰ was obviously less and the vital signs of the cases were stable; the heart beat and blood pressure of the cases in group Ⅱ at each time point increased significantly; there existed no obvious difference in recovery time between the 2 groups; the cases in group Ⅰ were more sedative and the cases number of satisfactory sedation scores were much bigger than that in group Ⅱ, and there were less cases with body movement response in recovery time. Conclusions Katamine plus dexemedetomidine is of good anesthetic effect in pediatric surgery, which produces good analgesic and sedative effect and can obviously decrease the side effect in respiratory circulation by pure application of katamine and the occurrence of postoperative body movement response.