94例小儿烧伤整形术氯胺酮麻醉时脉搏、血氧饱和度监测的分析  

An Analysis of SpO_2 Monitoring of 94 Pediatric Patients during Plastic Operation with Ketamine Anesthesia

作　　者：于瑞英[1] 罗炎[1] 

机构地区：[1]天津市第四医院麻醉科,300222

出　　处：《天津医药》2000年第3期151-152,共2页Tianjin Medical Journal

摘　　要：目的:观察小儿不同手术部位氯胺酮麻醉时,保留自主呼吸造成低氧血症情况。方法:选择小儿烧伤整形手术94例,按手术时间长短及手术部位分为3组:Ⅰ组,氯胺酮5mg·kg^(-1);肌注;Ⅱ组,氯胺酮2mg·kg^(-1)+安定0.2mg·kg^(-1)静注;Ⅲ组,氯胺酮2mg·kg^(-1)+羟丁酸钠80～100mg·kg^(-1)静注。Ⅱ、Ⅲ组均以0.1%氯胺酮静点维持麻醉。麻醉全程用惠普78352C型多功能监测仪连续监测血氧饱和度(SpO_2)。结果:发生低氧血症者28例占30%。诱导期18.1%(17/94),术中4.3%(4/94),苏醒期7.4%(7/94),诱导期比术中和苏醒期更易发生低氧血症(19<0.05)。面颈部手术57.1%(8/14),四肢手术25.0%(20/80),面颈部手术比四肢手术更易发生低氧血症(P<0.05)。非插管者32.1%(9/28),插管者28.8%(19/66),两组差异没有显著性(P>0.05)。结论:小儿氯胺酮麻醉低氧血症的发生在所难免,SpO_2监测能够预报临床不易被识别的早期低氧血症。因此,小儿氯胺酮麻醉应常规进行Sp为O_2监测及吸氧,面颈部手术应更加重视。Objective: To investigate the status of hypoxemia among different plastic surgeries on parts of body with ketamine anes-thesia in pediatric patients. Methods:94 children were divided into 3 groups depending on the methods of anesthesia:group 1, ketamine only, 5 mg·?kg-1, im; group 2, ketamine 2 mg·kg -1 plus valium 0.2 mg·kg-1, iv; group 3, ketamine 2 mg·kg-1 plus γ-OH 80 ~ 100 mg·g-1 iv.SpO2 was monitored constantly with HP 78352 C. Results: Anoxia was observed in 28 chil-dren (30%),while 17(18.1%) occurred in inducing phase,4(4.3% ) existing during the operations and 7(7.4%) oc-curred during recovery. It was easier to induce hypoxemia when the operation was performed on the face and neck. No sig-nificant difference between tracheal intubation and non-tracheal intubation. Conclusion: It is difficult to avoid hypoxemia un-der ketamine anesthesia. SpO2 monitoring can forecast hypoxemia earlier. SpO2 and inhaling oxygen must be emphasized es-pecially in pediatric patients during plastic surgery.

关 键 词：儿童 烧伤 氯胺酮 麻醉 脉搏 血氧饱和度 

分 类 号：R644[医药卫生—外科学] R725.2[医药卫生—临床医学]