氯胺酮静脉全身麻醉复合罗哌卡因骶管阻滞对腹股沟疝患儿术中应激反应的影响

Effects of intravenous anesthesia of ketamine combined with caudal block of ropivacaine on stress response in children with inguinal hernia

目的探讨氯胺酮静脉全身麻醉复合罗哌卡因骶管阻滞对腹股沟疝患儿术中应激反应的影响。方法选取2015年11月至2017年12月,保定市儿童医院82例腹股沟疝患儿的临床资料,通过随机数字表法分为对照组与试验组,每组患儿41例。对照组采用氯胺酮静脉全身麻醉,试验组采用氯胺酮静脉全身麻醉复合罗哌卡因骶管阻滞。统计2组麻醉前(T1)、麻醉后10 min(T2)、术后即刻(T3)、术后8 h(T4)应激反应指标[皮质醇、白细胞介素-6(interleukin 6,IL-6)]水平、氯胺酮用量、苏醒时间、术后5、60、120min时疼痛的改良面部表情评分(facial expression scoring,FLACC)及苏醒期躁动评分(awakening period score,AS)、不良反应发生率。结果T2时2组血清皮质醇、IL-6水平较T1时期增高,但试验组低于对照组(P<0.05),T3及T4时2组血清皮质醇、IL-6水平较T2时期降低,但试验组低于对照组(P<0.05);试验组氯胺酮用量少于对照组、苏醒时间短于对照组(P<0.05);术后5、60、120min试验组FLACC及AS分值低于对照组(P<0.05);试验组呕吐(7.32%)、躁动(12.20%)、嗜睡(9.76%)发生率低于对照组(P<0.05)。结论腹股沟疝患儿手术治疗过程中采取氯胺酮静脉全身麻醉复合罗哌卡因骶管阻滞,可减少氯胺酮用量,缩短苏醒时间,减轻术中应激反应程度,还有利于减轻术后疼痛感及躁动程度,且可降低不良反应发生率。

Objective To explore the effects of intravenous anesthesia of ketamine combined with caudal block of ropivacaine on stress response in children with inguinal hernia.Methods 82 cases of inguinal hernia in Baoding Children’s hospital from November 2015 to December 2017 were randomly divided into control group and study group.The control group received intravenous anesthesia of ketamine,and the study group received intravenous anesthesia of ketamine combined with caudal block of ropivacaine.The levels of stress response index[cortisol,interleukin-6(IL-6)]before anesthesia(T1),10 min after anesthesia(T2),immediately after operation(T3),and 8 hours after operation(T4),dose of ketamine,time of awakening,scores of pain(FLACC)and restlessness during the awakening period(AS)5,60 and 120 minutes after operation and the incidence of adverse reactions of two groups were compared.Results The levels of serum cortisol and IL-6 in T1 in the two groups were higher than those in T2,but the study group was lower than the control group(P<0.05).The levels of serum cortisol and IL-6 in T3 and4 in the two groups were lower than those in T2,and the study group was lower than the control group(P<0.05).The dosage of ketamine in the study group was less than that in the control group,and the time of awakening was shorter than that in the control group(P<0.05).The scores of FLACC and AS in the study group were lower than those in the control group at 5,60,and 120 minutes after operation(P<0.05).The incidence of vomiting(7.32%),restlessness(12.20%)and lethargy(9.76%)in the study group were lower than those in the control group(P<0.05).Conclusion Intravenous anesthesia of ketamine combined with caudal block of ropivacaine in the operation of children with inguinal hernia can reduce the dosage of ketamine,shorten the time of awakening,reduce the degree of stress reaction during the operation,and reduce the postoperative pain and restlessness.Besides,it can reduce the incidence of adverse reactions.