氯胺酮基础麻醉加硬外阻滞在小儿腹股沟术中的应用  

APPLICATION OF KETAMINE BASIC ANESTHESIA PLUS LIDOCAINE EPIDURAL ANESTHESIA IN PEDIATRIC GROIN SURGERY

作　　者：张雪玲[1] 

机构地区：[1]宁夏西吉县人民医院麻醉科,西吉756200

出　　处：《现代预防医学》2011年第22期4612-4613,共2页Modern Preventive Medicine

摘　　要：[目的]观察小儿腹股沟手术应用氯胺酮基础麻醉加2%利多卡因硬外阻滞的临床效果和安全性。[方法]选择拟施腹股沟手术患儿60例,随机分成两组,每组30例。A组为氯胺酮基础麻醉加氯胺酮静脉麻醉;B组为氯胺酮基础麻醉加硬外阻滞。观察氯胺酮基础麻醉后,手术开始时以及手术结束时,患儿心率(HR)、收缩压(SBP)、舒张压(DBP)、脉搏血氧饱和度(SPO2)变化及手术期间的肢动挣扎、恶心呕吐发生率,氯胺酮总用量及术后清醒时间。[结果]A组HR、BP手术开始时以及手术结束时与基础麻醉后相比均显著升高。B组BP之时间点无明显改变,但手术开始及手术结束时均较A组为低,B组HR在手术开始时以及手术结束时较基础麻醉后以及A组相应时间点减慢。两组SPO2无明显变化。B组氯胺酮总用量及术后清醒时间均较A组明显减少。B组肢动挣扎例数显著少于A组。恶心呕吐发生率两组无明显差异。[结论]氯胺酮基础麻醉加硬外阻滞对于患儿腹股沟手术无明显血液动力学和SPO2方面的改变,可稳定HR、减少氯胺酮用量,其麻醉效果安全确切,值得在临床上推广应用。[Objective]To observe the clinical effect and safety of ketamine basic anesthesia plus 2% lidocaine epidural anesthesia in pediatric groin surgery.[Methods]60 pediatric patients that received groin surgery were randomly divided into two groups with 30 cases in each group.Group A used ketamine basic anesthesia plus ketamine intravenous anesthesia;Group B used ketamine basic anesthesia plus epidural block.We observed the Heartbeat Rate（HR）,the change of Systolic Blood Pressure（SBP）,Diastolic Blood Pressure（DBP）,Pulse Oxygen Saturation（SPO2）,and limb struggling during the surgery process,the incidence of nausea and vomiting,the total consumption amount of ketamine as well as the postoperative recovery duration at the beginning of the surgery and after the surgery.[Results]For Group A,HR and BP at the beginning of and after the surgery were significantly increased compared with the basic anesthesia.For Group B,the time point of BP didn＇t have significant changes,however,it was universally lower than Group A at the beginning of and after the surgery,compared with the basic anesthesia and the corresponding duration,HR of Group B at the beginning of and after the surgery were decreased than Group A.SPO2 of both Groups had no significant changes.The total consumption amount of ketamine and the postoperative recovery duration of Group B was significantly reduced than those in Group A.The limb struggling during surgery of Group B patients was significantly less than that of Group A.The incidence of nausea and vomiting had no significant difference between the two groups.[Conclusion]Ketamine basic anesthesia plus epidural block for pediatric groin surgery had no significant changes in terms of hemodynamic and SPO2,it can stabilize HR,reduce the quantity of ketamine consumption,the anesthetic effect is safe and accurate,which should be widely promoted in the clinical application.

关 键 词：利多卡因 硬外阻滞 小儿 氯胺酮 

分 类 号：R614[医药卫生—麻醉学]