小剂量氯胺酮对丙泊酚所致儿童不自主运动的影响

Effects of low dose ketamine on propofol-induced involuntary body movements in children

目的研究不同剂量氯胺酮预处理对丙泊酚引起患儿不自主体动反应的影响,并寻找最佳剂量。方法择期手术患儿150例,男86例,女64例,年龄3~12岁,正常体重(标准体重±20%),ASA分级Ⅰ、Ⅱ级,采用随机数字表法将患儿分为5组(每组30例):丙泊酚组(P组)、氯胺酮0.5 mg/kg组(K1组)、氯胺酮0.6 mg/kg组(K2组)、氯胺酮0.7 mg/kg组(K3组)和氯胺酮0.8 mg/kg组(K4组)。P组予3 mg/kg丙泊酚泵注,K1组、K2组、K3组和K4组在丙泊酚泵注前2 min静脉注射相应剂量氯胺酮。比较各组患儿一般情况、手术时间、麻醉时间,比较各组患儿诱导前(T0)、插管时(T1)、手术开始时(T2)心率、呼吸频率、MAP、SpO2,比较各组患儿体动反应发生率、拔管时间、麻醉恢复期不良反应发生情况及SAS镇静躁动评分(Ricker Sedation Agitation Scale,SAS)和Ramsay镇静评分。结果各组患儿一般情况、手术时间、麻醉时间比较,T0、T1、T2时心率、呼吸频率、MAP及SpO2比较,差异均无统计学意义(P>0.05)。K2组、K3组、K4组体动反应发生率明显低于P组(P<0.05),且K3组、K4组体动反应发生率低于K1组(P<0.05)。K3组、K4组拔管时间明显长于P组(P<0.05),K3组、K4组拔管时间明显长于K1组,K4组拔管时间明显长于K2组(P<0.05)。各组患儿麻醉恢复期躁动发生率、SAS及Ramsay镇静评分比较,差异无统计学意义(P>0.05)。结论小剂量氯胺酮可安全、有效地降低儿童患者由丙泊酚引起的不自主体动反应,且0.6 mg/kg是最佳剂量。

Objective To investigate the effect of different doses of ketamine pretreatment on propofol-induced involuntary body movements in children and to find the best dose.Methods Using random number table method,150 pediatric patients undergoing elective surgery under general anesthesia(86 males and 64 females,aged 3-12 years,American Society of Anesthesiologists(ASA)physical statusⅠorⅡ)were divided into propofol group(group P),ketamine 0.5,0.6,0.7,0.8 mg/kg group(groups K1,K2,K3 and K4),with 30 cases in each group.Patients in group Pwere intravenously administered with 3 mg/kgpropofol;patients in groups K1,K2,K3 and K4 were injected with corre-sponding doses of ketamine 2 min before propofol,followed by the same amount of propofol administration.The general data,operation time,anesthesia time,heart rate(HR),respiratory,mean arterial pressure(MAP)and pulse oxygen saturation(SpO2)at induction(T0),intubation(T1),and operation initiation(T2),as well as incidence of body movements,extubation time,adverse reactions during anesthesia recovery,Ricker Sedation Agitation Scale(SAS)and Ramsay score were compared among the groups.Results There were no significant differences in general data,operation time,anesthesia time,HR,MAP,SpO2,SAS and Ramsay score at different time points among the 5 groups(P>0.05).The incidence of body movements in groups K2,K3 and K4 was significantly lower than that in group P(P<0.05),and that in groups K3 and K4 was lower than that in group K1(P<0.05).However,the extubation time in group K3 and group K4 was significantly longer than that in group P(P<0.05),as well as that in group K1(P<0.05),and that in group K4 was significantly longer than that in group K2(P<0.05).There was no significant difference in the incidence of adverse reactions in each group during anesthesia recovery(P>0.05).Conclusions Small dose of ketamine can safely and effectively reduce the incidenceof involuntary bodymovementsinducedbypropofol inchildrenand 0.6mg/kgisthe best dose.