小儿氯胺酮和咪唑安定、丙泊酚联合用药的临床观察  

Clinicl Observation of Ketamine,Midazolam and Propofol Combined Anesthesia in Children

作　　者：金泉英[1] 付月珍[1] 马亚萍[1] 周益人[1] 王则娅[1] 王春[1] 

机构地区：[1]上海市儿童医院,上海200040

出　　处：《基层医学论坛》2006年第5期391-393,共3页The Medical Forum

摘　　要：目的通过氯胺酮和咪唑安定、丙泊酚联合用药的临床观察,为小儿氯胺酮麻醉选择合理有效、经济安全的联合用药方法。方法选择ASAⅠ￣Ⅱ级先天性腹股沟斜疝疝囊高位结扎术的患儿60例,随机分成四组:氯胺酮组(K组)、氯胺酮加咪唑安定组(KM组)、氯胺酮加丙泊酚组(KP组)、氯胺酮加咪唑安定和丙泊酚组(KMP组),记录麻醉前、诱导后、切皮、结扎疝囊及术毕时的HR、MBP、SPO2并统计分析,观察术毕麻醉复苏情况,比较苏醒时间和氯胺酮加药次数。结果与术前比较,K组的HR仅在诱导后和术毕有显著性差异;三组联合用药组的HR在每一个时点均呈非常显著性差异(P<0.01);KP组的MBP除切皮外三个时点呈显著性差异,KMP组诱导后术毕呈非常显著性差异,KM组仅术毕呈非常显著性差异;三组联合用药组中KM组和KMP组的SPO2在诱导后有显著性差异(P<0.05),KP组呈非常显著性差异(P<0.01);与K组比较,KMP组仅诱导后的MBP有显著性差异;KM组每一个时点的MBP有显著性差异;而KP组结扎、术毕的HR以及诱导后、切皮、结扎时的MBP有显著性差异,诱导后的SPO2有显著性差异(P<0.01)。与K组比较,KMP组氯胺酮加药次数明显减少,呈显著性差异(P<0.05)。四组病人术后均无恶心呕吐,躁动发生率K组最高,达26.67%,三组联合用药组均低于15%。结论就本研究而言,氯胺酮与丙泊酚联合使用麻醉效能强,血液动力学平稳,苏醒快,缺点是明显的呼吸抑制,但与另两组联合用药组相比,控制好丙泊酚用药速度,氯胺酮与丙泊酚用于小儿短小的先天性畸形矫治术是一种更为可取的麻醉方法。Objective To observe the effects of Ketamine , Midazolam and Propofol combined anesthesia and compared with that of Ketamine used only . Methods Sixty paediatric cases undergoing hernial surgery with ASA Ⅰ - Ⅰ grade were randomly divided into four groups （n=15 each）： group Ketamine （K）,group Ketamine-Midazolam（KM）, Ketamine-Propofol （KP） and Ketamine-Midazolam, Propofol （KMP）.HR,MBP,SPO2 were recorded at time-point before anesthesia.,afte induction, onset of operation, ligation and finished respectively. The number of medication and awaken time were observed. Results HR decreased significantly at each time-point in three groups of combined anesthesia （P〈0.01）,MBP fall was mord effective in group KP and group KMP.But compared with group K,the controlling of HR and MBP was better in group KP than in group KMP.The awaken time of group KP was the shortest.The number of medication was less in group KMP than that in other groups.Conclusion The Ketamine and Propofol combined anesthesia is more suitable for minor surgery to children.

关 键 词：氯胺酮 咪唑安定 丙泊酚 联合用药 小儿麻醉 

分 类 号：R726.1[医药卫生—儿科]