小剂量氯胺酮联合低血浆靶浓度瑞芬太尼用于小儿全麻的效果观察

Effect of small dose of ketamine combined with low target plasma concentration of remifentanil on treating pediatric anesthesia

目的探讨小剂量氯胺酮联合低血浆靶浓度瑞芬太尼用于小儿全麻的效果观察。方法选取海口市妇幼保健院2012年4月至2013年12月收治的74例腹股沟斜疝择期手术患儿作为研究对象,采用随机数字表法分为对照组(n=37)和观察组(n=37)。对照组给予氯胺酮联合咪唑安定全麻,观察组给予靶控输注小剂量氯胺酮联合瑞芬太尼全麻,比较两组患儿麻醉情况。结果对照组插管后心率(HR)、平均动脉压(MAP)、脑电双频指数(BIS)、听觉诱发电位指数(AEPI)指标显著高于插管前,差异有统计学意义(P<0.05);对照组手术结束时BIS、AEPI指标显著低于麻醉前,差异有统计学意义(P<0.05);观察组手术结束时HR、MAP、BIS、AEPI指标显著低于麻醉前,差异有统计学意义(P<0.05);观察组氯胺酮用量、苏醒时间、术中体动及苏醒期躁动发生率均显著低于对照组,且差异有统计学意义(P<0.05)。结论小儿全麻采用小剂量氯胺酮联合低血浆靶浓度瑞芬太尼,能降低氯胺酮用量,保持血液动力学稳定,麻醉效果良好。

Objective To explore the effects of small dose of ketamine combined with low target plasma concentration of remifentanil on treating pediatric anesthesia. Methods 74 patients with inguinal hernia undergoing elective operation were randomly divided into two groups. The control group was given ketamine combined with midazolam anesthesia;the observation group was given target controlled infusion of small dose of ketamine combined with remifentanil. Results In the control group,after intubation,heart rate（HR）,mean artery pressure（MAP）,BIS,auditory evoked potential index（AEPI） was significantly higher than those of before intubation（P0.05）. BIS and AEPI of the treatment group were significantly lower than those of control group at the end of surgery before anesthesia（P0.05）. HR,MAP,BIS and AEPI of control group were significantly lower than those at the end of observation group during the operation before anesthesia（P0.05）. In the observation group,ketamine dosage, recovery time,intraoperative body movement and restlessness incidence were significantly lower than those of control group（P0.05）. Conclusion General anesthesia with small dose of ketamine combined with low target plasma concentration of remifentanil could reduce the ketamine to maintain hemodynamic stability and good anesthetic effect.