右美托咪定复合氯胺酮与单纯氯胺酮在患儿烧伤换药镇静中的比较  

Effect of ketamine or ketamine combined with dexmedetomidine in dressings changing in pediatric burn patients

作　　者：陈明华[1] 张铨[2] 胡贵[2] 吴祖煌[3] 张西京[1] 

机构地区：[1]第四军医大学附属西京医院麻醉科,西安市710032 [2]福州总医院附属第一医院麻醉科 [3]福州总医院附属第一医院烧伤整形科

出　　处：《临床麻醉学杂志》2012年第11期1055-1057,共3页Journal of Clinical Anesthesiology

摘　　要：目的观察右美托咪定复合氯胺酮用于小儿烧伤换药的临床镇静效果及安全性。方法分别对20例烧伤住院患儿的两次换药采用不同镇静方式。A镇静方式为右美托咪定6μg.kg-1.h-1静脉泵注10min后静注氯胺酮1mg/kg,随后右美托咪定0.6μg.kg-1.h-1维持,根据换药中的体动情况按0.5mg/kg追加氯胺酮。B镇静方式用等容量生理盐水代替右美托咪定,其余方法与A相同。监测静脉泵注前(T1)、静脉泵注10min后(T2)、换药开始后1min(T3)、5min(T4)、10min(T5)、换药结束时(T6)患儿的MAP、HR、RR、PETCO2、SpO2等指标,并对小儿作Ramsay镇静评分,记录换药完成时间、氯胺酮使用量、苏醒期睁眼或体动时间,观察小儿苏醒期躁动(PAED)评分及恶心呕吐情况,记录小儿父母及换药医师满意度评分。结果 T2～T6时A镇静方式的MAP明显低于,HR明显慢于B镇静方式(P<0.05);T2时Ramsay镇静评分A镇静方式明显低于B镇静方式(P<0.05)。两种镇静方式的氯胺酮使用量差异无统计学意义,A方式苏醒时间长于B方式,但PAED评分、恶心呕吐评分及父母满意度明显高于B方式(P<0.05)。结论右美托咪定复合氯胺酮应用于小儿烧伤换药的镇静,患儿血流动力学指标较为平稳,且对呼吸无明显影响。本研究中虽然右美托咪定不能减少氯胺酮使用量,且可稍延长患儿苏醒时间,但可以提高患儿苏醒质量,可以安全用于小儿烧伤换药的镇静。Objective To evaluate the effect of ketamine or ketamine combined with dexmedetomidine in dressings changing in pediatric burn patients. Methods Twenty pediatric burned patients undergoing dressings changing were allocated to receive ketamine plus dexmedetomidine （group A, dexmedetomidine 6 μg·kg^-1·h^-1 and ketamine 1 mg/kg 10 rain after the beginning of dexmedetomidine） or ketamine （group B, ketamine 1 mg/kg）. Additional 0.5 mg/kg ketamine was injected under inadequate anesthesia. During the procedure, MAP, HR, RR, PETCO2, SpO2 and Ramsay scale were recorded at baseline （T1）, 10 rain after infusion（T2 ）, lmin（T3 ）, 5min（T4 ）, 10 min（T5） after dressings changing, and at the end changing（T6 ）. The operation time, ketamine consumption and eyes-open time were recorded pediatric anesthesia emergence delirium（PAED）and postoperative nausea and vomiting were observed in PACU. We also compared satisfaction of the surgeons and the parents. Results At T2-T6, the hemodynamics in group A was more stable than that of group B（P〈0. 05）. Ramsay scale in group A was lower than that in group B at T2 （P〈0. 05）. The incidences of respiratory depression in the two groups were similar. Eyes-open time was longer in group A than group B, but PAED-scale, nausea and vomiting scale were more lower in group A（P〈0. 05）. Parents＇ satisfaction score was higher in group A （P ~ 0.05）. Conclusion Dexemedetomidine combined with ketamine can be used safely in pediatric bum patients with more stable hemodynamics and respiratory function, prolonged recovery time and better recovery quality.

关 键 词：右美托咪定 小儿烧伤 换药术 氯胺酮 镇静 

分 类 号：R726.1[医药卫生—儿科]