地塞米松复合氯胺酮抑制阑尾牵拉反应的效果观察

Effect of Dexamethasone with Subdose Ketamine on Restraining the Pulling-dragging Reflex During Appendectomy

目的 观察地塞米松复合小剂量氯胺酮抑制阑尾牵拉反应的效果。方法 114例ASAⅠ～Ⅱ级阑尾切除术病人 ,T1 1～L1 间隙硬膜外麻醉下行阑尾切除术。随机分 3组 ,每组 3 8例 ,Ⅰ组在切腹膜时静注地塞米松 10mg和氯胺酮 0 5mg/kg ,Ⅱ组在切皮时静注哌替啶 5 0mg和氟哌啶 2 5mg ,Ⅲ组为对照组 ,单纯硬膜外麻醉不用辅助药物。观察并详细记录阑尾牵拉反应情况、牵拉阑尾时的镇静状态和脉搏氧饱和度与平均动脉压的变化。结果 Ⅰ、Ⅱ、Ⅲ组抑制牵拉反应的优良率分别为 10 0 %、81 5 8%和18 42 %,Ⅰ组与其余两组相比 ,P <0 0 1,差异显著 ;Ⅰ组和Ⅱ组镇静状态无差异 ,但与Ⅲ组相比 ,P <0 0 1;I组SpO2 和MAP注药前后无明显差异 ,与II组比较有显著差异 ( P <0 0 5 )。

Objective To investigate the effect of dexamethasone with subdose ketamine on restraining the pulling-dragging reflex during appendectomy. Methods 114 ASA grade Ⅰ～Ⅱpatients of appendectomy undergoing T 11 ～L 1 epidural anesthesia were randomly divided three groups,each group containing 38 cases. Group Ⅰ recieved the dexamethasone 10mg and ketamine 0 5mg/kg by venous injection before opening abdominal cavity, groupⅡ received pethidine 50mg and droperidol 2 5mg before begining operation, and group Ⅲ without any drugs served as control. The pulling-dragging reflex of appendix, the sedative state at pulling-dragging appendix and the change of pulse oxygen saturation (SpO 2) or mean arterial pressure (MAP) were recorded and analyzed. Results The excellent rates of groupsⅠ, Ⅱ and Ⅲ were 100%, 81 58% and 18 42% respectively,and there was significant difference between group I and the other groups (P<0 01). The sedative state was similar between groupsⅠ and Ⅱ, but the sedative state of groups I and II was better than that of groupⅢ (P<0 01). The SpO 2 and MAP had not significant difference before and affter giving the drugs in group I, but the SpO 2 and MAP of group I were better than those of group II (P< 0 05). Conclusions Dexamethasone with subdose ketamine can effectively restrain the pulling-dragging reflex of appendix.