艾司氯胺酮对上呼吸道感染病儿骨科手术麻醉效果

ANESTHETIC EFFECT OF S-KETAMINE IN ORTHOPEDIC SURGERY FOR CHILDREN WITH UPPER RESPIRATORY TRACT INFECTION

目的探讨艾司氯胺酮复合丙泊酚辅助神经阻滞对行骨科短小手术上呼吸道感染病儿麻醉效果。方法选取合并上呼吸道感染行骨科短小手术治疗儿童120例,ASA分级Ⅰ~Ⅱ级,随机分为单纯丙泊酚诱导对照组(C组)、0.5 mg/kg艾司氯胺酮复合丙泊酚诱导观察组(E_(1)组)、1.0 mg/kg艾司氯胺酮复合丙泊酚诱导观察组(E_(2)组)。3组病儿麻醉诱导后进行神经阻滞,观察进神经阻滞刺激针(T_(2))时病儿体动反应及呛咳、喉痉挛、屏气、低氧血症、低血压、苏醒期躁动等围术期不良反应的发生情况;比较3组麻醉诱导前(T_(0))、麻醉诱导后(T_(1))、T_(2)、手术开始时(T_(3))、手术结束时(T_(4))的平均动脉压(MAP)和心率(HR)以及术后苏醒时间。结果3组病儿T_(2)时体动反应、围术期吸痰次数>2次及喉痉挛发生率E_(2)组低于C组和E_(1)组,差异有统计学意义(χ^(2)=6.771~14.892,P<0.05);T_(1)时3组MAP比较,C组低于E_(1)、E_(2)组,差异有统计学意义(F=13.861,P<0.05);T_(2)时3组HR比较差异有统计学意义(F=10.579,P<0.05),C组明显高于E_(1)、E_(2)组,E_(1)组明显高于E_(2)组;苏醒时间C组明显长于E_(1)、E_(2)组,差异有统计学意义(F=31.600,P<0.05)。结论艾司氯胺酮1.0 mg/kg复合丙泊酚用于全麻诱导能更好提供镇静镇痛效果,保持循环稳定,并能减少呼吸道不良事件的发生。

Objective To investigate the anesthetic effect of S-ketamine combined with propofol assisting peripheral nerve block in short-term orthopedic surgery for children with upper respiratory tract infection.Methods A total of 120 children with upper respiratory tract infection undergoing short-term orthopedic surgery were enrolled,with an ASA grade ofⅠ-Ⅱ,and the children were randomly divided into propofol induction control group(group C),0.5 mg/kg S-ketamine+propofol induction observation group(group E_(1)),and 1.0 mg/kg S-ketamine+propofol induction observation group(group E_(2)).Peripheral nerve block was performed after anesthesia induction,and the three groups were observed in terms of body motion reaction during the injection of nerve block stimulation needle(T_(2))and adverse reactions such as bucking,laryngeal spasm,breath holding,hypoxemia,hypotension,and emergence agitation during the perioperative period;the three groups were compared in terms of mean arterial pressure(MAP)and heart rate(HR)before anesthesia induction(T_(0)),after anesthesia induction(T_(1)),T_(2),at the beginning of surgery(T_(3)),and at the end of surgery(T_(4))and awakening time after surgery.Results Compared with groups C and E_(1),group E_(2) had a significantly lower incidence rate of body motion reaction at T_(2),a significantly lower proportion of children with perioperative sputum aspiration>2 times,and a significantly lower incidence rate of laryngeal spasm(χ^(2)=6.771-14.892,P<0.05).Group C had a significantly lower MAP than groups E_(1) and E_(2) at T 1(F=13.861,P<0.05).There was a significant diffe-rence in HR between the three groups at T_(2)(F=10.579,P<0.05);group C had a significantly higher HR than groups E_(1) and E_(2),and group E_(1) had a significantly higher HR than group E_(2).Group C had a significantly longer awakening time than groups E_(1) and E_(2)(F=31.600,P<0.05).Conclusion S-ketamine 1.0 mg/kg combined with propofol can provide better sedative and analgesic effects in general anesthesia induction,maintain stable circulation,and reduce respiratory adverse events.