麻醉苏醒期不同剂量多沙普仑对患儿心率的影响

Influences of different doses of doxapram on heart rate during the anesthetic recovery period in pediatric surgery patients

目的观察麻醉苏醒期不同剂量的多沙普仑对患儿心率(HR)的影响。方法选取2015年5月~2017年8月于日照市中心医院在氯胺酮全凭静脉麻醉下行斜疝或鞘膜积液手术患儿80例,性别不限,年龄1~6岁,ASAⅠ~Ⅱ级,采用随机数字表法将其分为A组、B组、C组、D组四组,每组20例。麻醉诱导:静推氯胺酮2 mg/kg,依托咪酯0.01 mg/kg。麻醉维持:间断推注氯胺酮1 mg/kg、依托咪酯0.01 mg/kg。麻醉复苏:A组、B组和C组静注多沙普仑剂量分别为1.5 mg/kg、1.0 mg/kg、0.5 mg/kg,D组推注生理盐水2 mL,时间均为1 min。记录患儿在病房时(T0)的HR;抱入手术室至切皮前(T1)、切皮至手术结束(T2)、推注多沙普仑(或生理盐水)前、后5 min(T3、T4)时段的最高HR。比较各组推药前后心率增幅的差异和心电图的变化,观察各组肺水肿、室颤的例数。结果A组、B组、C组、D组四组患儿HR在T1时和T2时比较,差异均无统计学意义(P>0.05);T4时A组、B组和C组患儿的HR分别为(156.9±7.2)次/min、(143.2±4.2)次/min、(127.2±4.8)次/min,较T3时[(111.6±6.3)次/min、(109.5±5.8)次/min、(109.6±4.1)次/min]加快,差异均有统计学意义(P<0.05);D组患儿T4时的HR(114.8±4.8)次/min与T3时(108.5±4.7)次/min比较,差异无统计学意义(P>0.05);A组、B组、C组、D组四组患儿的HR在T4时比较差异均有统计学意义(P<0.05);A组、C组和D组患儿T4时分别与T1、T2时比较,HR加快,差异均有统计学意义(P<0.05),而B组的HR比较差异无统计学意义(P>0.05);推药前后,A组、B组、C组、D组患儿的HR增幅分别为(45.4±5.4)次/min、(33.7±2.8)次/min、(17.7±3.1)次/min、(6.4±1.0)次/min,差异均有统计学意义(P<0.05)。T3和T4时四组心电图类型均为窦性心动过速,均未发现肺水肿和室颤病例。结论氯胺酮全凭静脉麻醉的患儿苏醒期静注多沙普仑1.0 mg/kg以下引发心率增幅和最高心率较小,安全性高。

Objective To evaluate the influences of different doses of doxapram on heart rate(HR)during the anesthetic recovery period in pediatric surgery patients.Methods According to random number table method,eighty ASAⅠ-Ⅱchildren(1 to 6 years old),treated and scheduled for operation in indirect inguinal hernias or hydroceles under general anesthesia with ketamine in Rizhao central Hospital from May 2015 to August 2017,were divided into group A,group B,group C and group D,with 20 cases in each group.They were received 2 mg/kg ketamine and 0.01 mg/kg etomidate during anesthesia induction and received 1 mg/kg ketamine and 0.01 mg/kg etomidate by discontinuous intravenous injection to maintain the depth of anesthesia.During anesthesia recovery period,group A,group B and group C were respectively received 1.5 mg/kg,1.0 mg/kg,0.5 mg/kg doxapram,and control group D received 2 mL normal saline in 1 minute.The HR of pediatric surgery patients in the ward(T0),the maximum HR during the period from patients were carried into the operating room to before cuting skin(T1),intraoperative period(T2),5 minutes before or after received different doses of doxapram or normal saline(T3,T4)were recorded.The difference of increase in HR and the changes of electrocardiogram from before to after received different doses of doxapram or normal saline in all groups were compared.The number of cases of pulmonary edema or ventricular fibrillation were observed.Results There was no significant difference in the mean HR of pediatric surgery patients at T1 than T4 among group A,group B,group C and group D(P>0.05).The mean HR at T4 group A,group B and group C were(156.9±7.2)beats/min,(143.2±4.2)beats/min and(127.2±4.8)beats/min,respectively,which were significantly higher than corresponding(111.6±6.3)beats/min,(109.5±5.8)beats/min and(109.6±4.1)beats/min at T3(P<0.05).There was no significant difference in the mean HR in group D between T4 and T3 with(114.8±4.8)beats/min versus(108.5±4.7)beats/min(P>0.05).There were significant differences in HR at T4 between group A,group B,group C and group D(P<0.05),and HR at T4 in group A,group C and group D were also significantly higher than those at T1 and T2(P<0.05),except group B(P>0.05).Before and after received different doses of doxapram or normal saline,the increase of HR in group A,group B,group C and group D were(45.4±5.4)beats/min,(33.7±2.8)beats/min,(17.7±3.1)beats/min and(6.4±1.0)beats/min,respectively,and there were significant differences among them(P<0.05).The electrocardiogram types at T3 and T4 were all sinus tachycardia in all groups.No cases of pulmonary edema or ventricular fibrillation were found.Conclusion During the anesthetic recovery period,for the pediatric surgery patients who undergone total intravenous general anesthesia with ketamine,the heart rate increase and maximum heart rate caused by intravenous infusion of doxapram 1.0 mg/kg are small and can be safely applied.