探讨氯胺酮、异丙酚复合利多卡因用于小儿腹股沟斜疝手术麻醉的临床价值

The clinical value of ketamine and propofol combined with lidocaine for anesthesia in children undergoing indirect inguinal hernia surgery

目的探讨氯胺酮、异丙酚复合利多卡因用于小儿腹股沟斜疝手术麻醉的临床价值。方法80例实施腹腔镜疝气修补手术的腹股沟斜疝患儿,依据随机数字表法分成对照组与研究组,每组40例。对照组手术中应用氯胺酮麻醉,研究组手术中应用氯胺酮、异丙酚复合利多卡因麻醉。对比两组麻醉效果、术中生命体征指标、术后麻醉苏醒时间、全身麻醉(全麻)苏醒期不良反应发生情况、认知功能评分。结果研究组麻醉优良率100.00%比对照组的87.50%高(P<0.05)。麻醉诱导前,对照组平均动脉压、心率分别为(96.42±2.43)mm Hg(1 mm Hg=0.133 kPa)、(101.24±3.58)次/min,研究组分别为(96.31±2.36)mm Hg、(101.15±3.50)次/min;插管后1 min,对照组平均动脉压、心率分别为(102.98±3.09)mm Hg、(109.45±3.39)次/min,研究组分别为(96.75±2.27)mm Hg、(101.68±3.12)次/min。插管后1 min,研究组平均动脉压、心率与麻醉诱导前对比,差异无统计学意义(P>0.05),而对照组平均动脉压、心率较麻醉诱导前显著增高(P<0.05)。研究组插管后1 min平均动脉压、心率低于对照组(P<0.05)。研究组术后自主呼吸恢复时间(7.89±2.82)min、睁眼时间(9.04±2.45)min、指令恢复时间(16.85±3.10)min短于对照组的(12.65±3.49)、(13.91±3.57)、(21.42±3.37)min(P<0.05)。研究组全麻苏醒期不良反应发生率低于对照组(P<0.05)。手术前,对照组简易精神状态检查量表(MMSE)、蒙特利尔认知评估量表(MoCA)评分分别为(26.65±2.74)、(26.98±2.65)分,研究组分别为(26.41±2.86)、(26.75±2.70)分;手术后,对照组MMSE、MoCA评分分别为(20.38±1.79)、(21.02±1.53)分,研究组分别为(23.15±2.03)、(23.59±1.94)分。手术后,两组MMSE、MoCA评分均较手术前降低,但研究组MMSE、MoCA评分均较对照组更高(P<0.05)。结论在小儿腹股沟斜疝手术中,应用氯胺酮、异丙酚复合利多卡因不仅可增强患儿的手术麻醉效果,维持术中生命体征稳定,还可加快患儿术后苏醒,减轻其认知功能损害,减少全麻苏醒期不良反应的发生,兼具麻醉有效性和安全性。

Objective To explore the clinical value of ketamine and propofol combined with lidocaine for anesthesia in children undergoing indirect inguinal hernia surgery.Methods A total of 80 children who underwent laparoscopic herniorrhaphy due to indirect inguinal hernia were included in this study.The selected cases were divided into a control group and a study group using a random number table method,with 40 cases in each group.The control group was anesthetized with ketamine,while the study group was anesthetized with ketamine,propofol and lidocaine.Comparison was made on anesthesia effect,intraoperative vital signs,postoperative anesthesia recovery time,incidence of adverse reactions during recovery from general anesthesia,and cognitive function score between the two groups.Results The anesthesia excellence rate of 100.00%in the study group was higher than 87.50%in the control group(P<0.05).Before induction of anesthesia,the mean arterial pressure and heart rate of the control group were(96.42±2.43)mm Hg(1 mm Hg=0.133 kPa)and(101.24±3.58)beats/min,and those of the study group were(96.31±2.36)mm Hg and(101.15±3.50)beats/min.1 min after intubation,the mean arterial pressure and heart rate of the control group were(102.98±3.09)mm Hg and(109.45±3.39)beats/min,and those of the study group were(96.75±2.27)mm Hg and(101.68±3.12)beats/min.1 min after intubation,the mean arterial pressure and heart rate in the study group were not statistically significant when compared with those before induction of anesthesia(P>0.05),while the mean arterial pressure and heart rate in the control group were significantly higher than those before induction of anesthesia(P<0.05).The mean arterial pressure and heart rate in the study group were lower than those in the control group 1 min after intubation(P<0.05).In the study group,the spontaneous breathing recovery time was(7.89±2.82)min,the eye opening time was(9.04±2.45)min and the command recovery time was(16.85±3.10)min,which were shorter than(12.65±3.49),(13.91±3.57)and(21.42±3.37)min in the control group(P<0.05).The incidence of adverse reactions during recovery from general anesthesia in the study group was lower than that in the control group(P<0.05).Before surgery,the scores of mini-mental state examination(MMSE)and Montreal cognitive assessment scale(MoCA)were(26.65±2.74)and(26.98±2.65)points in the control group,and(26.41±2.86)and(26.75±2.70)points in the study group.After surgery,MMSE and MoCA scores were(20.38±1.79)and(21.02±1.53)points in the control group,and(23.15±2.03)and(23.59±1.94)points in the study group.After surgery,MMSE and MoCA scores in both groups were lower than those before surgery,but MMSE and MoCA scores of the study group were higher than those of the control group(P<0.05).Conclusion In children undergoing indirect inguinal hernia surgery,the application of ketamine,propofol,and lidocaine can not only enhance the surgical anesthesia effect of children,maintain stable vital signs during surgery,but also accelerate postoperative recovery,reduce cognitive impairment,reduce adverse reactions during recovery from general anesthesia,and have both anesthesia effectiveness and safety.