三种氯胺酮复合麻醉在小儿唇裂修复术的应用比较

Application and Comparison of Combined Anesthesia Using Three Ketamines in Operations for Patients with Cleft Lip.

目的 :观察三种氯胺酮复合麻醉在小儿唇裂修复术中不行气管插管的可行性。方法 :选择 87例ASAI～II级单侧唇裂患儿 ,按随机双盲法将病人分为三组 ,A组 31例接受氯胺酮 +羟丁酸钠麻醉 ,B组 2 7例接受氯胺酮+咪达唑仑麻醉 ,C组 2 9例接受氯胺酮 +羟丁酸钠 +咪达唑仑麻醉。记录病人的一般情况、手术时间、呼吸抑制情况、术中追加氯胺酮次数、麻醉苏醒时间 ,并对数据进行统计学处理。结果 :麻醉苏醒时间C组 >A组 >B组 (P<0 .0 5 ) ;术中追加氯胺酮次数C组明显少于A、B组 (P <0 .0 1) ;B组有一例因呼吸抑制明显改用气管插管 ,呼吸抑制B组明显高于A、C组 (P <0 .0 1)。结论 :在保证呼吸道畅通的前提下 ,单侧唇裂患儿麻醉可采用不进行气管插管的方法 ,在药物选择方面以配伍使用小剂量的咪达唑仑 0 .0 1mg/kg +羟丁酸钠 5

Objective:To investigate the feasibility of combined anesthesia using three ketamines without tracheal intubation in repair of cleft lip.Methods:87 patients of unilateral cleft lip were randomly divided into A,B,C groups. Each group received general anesthesia using ketamine + sodium hydroxybutyrate acid, ketamine+midazoline, and ketamine +sodium hydroxybutyrate acid +midazoline, respectively.General condition of patients, operating time, inhibition of respiration, frequency of adding ketamine and awaking time of anesthesia were recorded and statistically analyzed.Results:Anesthesia awaking time of group C was longer than that of A and B group (P<0.05); Frequencies of adding ketamine in group C were obviously fewer than that in group A and B (P<0.01); Respiratory inhibition was obvious in group B compared to group A and C (P<0.01). In group B, a patient had to receive tracheal intubation because of respiratory inhibition.Conclusions:When respiratory tract was unobstructed, patients with incomplete cleft lip can receive combined anesthesia without tracheal intubation. As for drug selection ,small doses of midazoline (0.01mg/kg) and sodium hydroxybutyrate acid (50mg/kg) were considered to be safe adjuvants in combined anesthesia.