脑瘫患儿术前口服氯胺酮和咪唑安定混合液的临床观察

Effects of oral administration of ketamine combined with midazolam before operations on children with cerebral palsy

目的 比较脑瘫患儿术前口服氯胺酮、咪唑安定混合液与单纯肌注氯胺酮的优缺点。方法 选择脑瘫患儿60 例,随机分为观察组30例和对照组30例。观察组术前口服氯胺酮(6.0 mg/kg)和咪唑安定(0.3 mg/kg)混合液,对照组肌肉注 射氯胺酮(5.0 mg/kg)。观察用药前和用药后5、10、15 min时患儿的心率、呼吸、脉搏、血氧饱和度,以及术后精神状态和有无 并发症。结果观察组94％的患儿给药时合作,对照组仅有10％,两组间差异非常显著(P<0.01)。而对照组患儿的呼吸频 率和心率较观察组明显增快,两组间差异显著(P<0.05)。两组患儿麻醉诱导前脉搏、血氧饱和度正常,也无恶心、呕吐等并 发症;术后清醒时间及其他与麻醉有关的并发症,两组间无显著差异。术后随访有恐惧和抵触情绪的患儿观察组为9％,对照 组为83％,两组间差异非常显著(P<0.01)。结论患儿术前口服氯胺酮和咪唑安定混合液,镇痛和镇静效果良好。术中血 流动力学稳定,围手术期并发症无增加,术后患儿心理和精神状态稳定。口服氯胺酮和咪唑安定混合液作为脑瘫患儿术前用 药是安全和可靠的。

Objective To study the effects of oral administration of ketamine combined with midazolam before operations on children with cerebral palsy. Methods Sixty children with cerebral palsy scheduled for operative surgery were divided into two groups: MK group was pre-medicated with an oral mixture of ketamine 6.0 mg/kg and midazolam 0.3 mg/kg whereas IK group with intarmuscular ketamine 5.0 mg/kg. The effectiveness of preoperative sedation, intraoperative hemodyamics and perioperative complications were compared between the two groups. Results Most children in the MK group (94%) complied with the oral administration without struggling or crying, while 10% of children in the IK group did so (P<0.01). Heart and respiratory rates in the DC group were faster than in the MK group(P< 0.05). The intraoperative hemodyamics and the perioperation complications were similar between the two groups(P> 0.05) .There were no respiratory depression,nausea or vomit after surgery. Nine percent of children in the MK group appeared afraid and resistant on postoperative follow - up whereas 83 % of children in the IK group did so ( P< 0.01). Conclusions Premedication with oral ketamine and midazolam is effective and well accepted by young children without significant side effects.