婴幼儿直肠灌注氯胺酮-咪唑安定-阿托品混合液术前用药的评价  

Rectal midazolam,atropine and ketamine as premedication for infants and young children

作　　者：王炫[1] 蒋豪[2] 周志坚[1] 张学锋[1] 汤顺荣[1] 

机构地区：[1]复旦大学儿科医院麻醉科 [2]复旦大学中山医院麻醉科

出　　处：《中华麻醉学杂志》2006年第1期32-34,共3页Chinese Journal of Anesthesiology

摘　　要：目的评价婴幼儿术前直肠灌注氯胺酮混和咪唑安定、阿托品的可行性。方法 106 例择期手术患儿,年龄2个月～2岁,随机分为3组：M 组(n=39)术前直肠灌注咪唑安定0.5mg/kg、阿托品0.02mg/kg；MK 组(n=34)在 M 组基础上加用氯胺酮4mg/kg；MKK 组(n=33)在 M 组基础上加用氯胺酮8mg/kg。于用药前、用药后15min、与父母分离时、进入手术室时,对患儿进行镇静评分并记录用药期间副反应的发生情况。结果 MK 组和 MKK 组用药后各时点镇静评分均高于 M 组(P＜ 0.05)。与父母分离及进入手术室时,MK 组与 MKK 组患儿熟睡率高于 M 组(P＜0.05)；MKK 组静脉穿刺时患儿安静率为63%,高于 MK 组(32%)和 M 组(18%)(P＜0.05)。结论婴幼儿术前直肠灌注氯胺酮混合咪唑安定、阿托品安全、有效,效果优于单用咪唑安定。Objective To determine the effectiveness of preoperative sedation with rectal midazolam and atropine alone or combined with ketamine in infants and young children.Methods One-hundred and six ASA Ⅰ or Ⅱ infants and young children aged 2 months - 2 years scheduled for elective general surgical operation were studied in a double blind fashion. The patients were randomly divided into 3 groups： group M received rectal atropine 0.02 mg·kg^- 1 and midazolam 0.5 mg· kg^-1 （ n = 39） ; group MK and MKK received rectal atropine 0.02 mg· kg^- 1 , midazolam 0.5 mg·kg^-1 and ketamine 4 mg·kg^-1 （MK, n = 34） or 8 mg·kg^-1 （MKK, n = 33）. The patients were transferred from the ward to the operating room （OR） 30 min after rectal administration. Depth of sedation was evaluated before and 15 min after rectal administration; when the patients were separated from their parents and on arrival in OR using De Jong＇s sedation score system. SpO2 and HR were monitored in OR.Results The patients were better sedated in group MK and MKK than in group M after rectal administration. Significantly more patients were asleep on seperation from their parents and on arrival in OR in group MK and MKK than in group M. Significantly more patients were calm and not crying at venepuncture in group MKK （63%） and group MK （32%） than in group M （18%）. Conclusion Rectal midazolam combined with ketamine and atropine results in better preoperative sedation than rectal midazolam alone in infants and young children.

关 键 词：氯胺酮 灌注 局部 术前用药法 儿童 直肠灌注 氯胺酮-咪唑安定-阿托品混合液 术前用药 

分 类 号：R726.1[医药卫生—儿科]