右美托咪定与丙泊酚复合氯胺酮用于视网膜母细胞瘤患儿经股动脉穿刺行局部化疗的麻醉效果比较

Effects of dexmedetomidine and propofol used alone or combined with ketamine in local chemotherapy through ophthalmic artery of retinoblastoma in pediatric patients

目的评价右美托咪定与丙泊酚单独复合或联合复合氯胺酮用于视网膜母细胞瘤(retinoblastoma,RB)患儿经股动脉穿刺行眼动脉局部化疗的麻醉效果,比较几种用药方法的安全性与可行性。方法择期经股动脉穿刺行眼动脉局部化疗的RB患儿60例,随机分为3组(n=20):D组、P组和DP组。所有患儿入室后静脉注射阿托品0.02 mg/kg和氯胺酮2.0mg/kg麻醉诱导,同时D组给予右美托咪定1.0μg/(kg·h),P组给予丙泊酚10 mg/(kg·h),DP组给予右美托咪定0.5μg/(kg·h)复合丙泊酚5 mg/(kg·h),分别泵注维持至术毕。记录患儿入室(T_0)、手术开始即刻(T_1)、手术后10 min(T_2)、化疗药注射即刻(T_3)、术毕即刻(T_4)、苏醒即刻(T_5)各时间点患儿BIS、NBP、HR、RR和SpO_2,记录各组患儿氯胺酮总用量和阿托品追加次数、手术时间、苏醒时间、呼吸抑制和术后躁动等不良反应的发生情况。结果与T_0比较,三组患儿在T_2,3,4时BIS值降低(P<0.05),P组T_3,4时NBP降低(P<0.05)。三组HR、RR和SpO_2各时间点差异无统计学意义。与D组比较,P组和DP组氯胺酮总用量减少(P<0.05),追加次数减少(P<0.01)。P组呼吸抑制率明显高于D组与DP组(P<0.01)。三组手术时间、苏醒时间及阿托品使用率比较差异无统计学意义。所有患儿均未发生苏醒期躁动。结论在RB患儿经股动脉行眼动脉局部化疗的手术中,采用氯胺酮诱导,继以右美托咪定0.5μg/(kg·h)与丙泊酚5 mg/(kg·h)联合泵注维持可产生良好的镇静镇痛效果,且不良反应发生率低,是较适宜的麻醉组合。

Objective To evaluate the clinical value of dexmedetomidine and propofol used separately or in combination with ketamine in local chemotherapy through ophthalmic artery of retinoblastoma in pediatric patients. Methods 60 children with retinoblastoma were randomly divided into three groups ： group D, group P and group DP. Subjects in each group were given atropine 0.02 mg/kg and ketamine 2.0 mg/kg as induced anesthesia. The dose of each anesthetic was maintainted at the same time. Femoral artery puncture began soon after the children fell asleep. BIS, BP, HR, RR and SpO2 of these patients were recorded at different time points. The total amount of ketamine, cases who needed additional ketamine and atropine, the operation time and awakening time were recorded as well. Also, the incidence of adverse events such as respiratory depression and postoperative agitation was observed. Results Compared to To, BIS decreased from T2 to T4 in these groups, while NBP was reduced from T3 to T4 in group P. There was no significant difference of HR, RR and SpO2 between these three groups at each time point. Compared to group D, the total amount and additional injection of ketamine was significantly reduced in group P and DP （ P 〈 0.05 or P 〈 0.01 ）. There were far more respiratory depression events in group P than in the other two groups. There was no significant difference in postoperative recovery status between these groups. Conclusions During local chemotherapy through ophthalmic artery in pediatric patients of RB, ketamine, when combined with dexmedetomidine andmaintained at the dose of 0. 5μg/（ kg·h） or with propofol maintained at the dose of 5 rag/（ kg·h）, can produce effective sedation and analgesia with few adverse reactions. This should be a suitable combination of anesthesia in operations of this kind.