氯胺酮、七氟醚、瑞芬太尼和异丙酚对小儿斜视手术眼心反射发生率的影响  

Impact of Ketamine,Sevoflurane,Propofol and Remifentanil on Oculocardiac Reflex in Pediatric Strabismus Surgery

作　　者：贾真[1] 耿丽娜[1] 朱平增[1] 焦岩[1] 杨彦军[1] 乔治[1] 

机构地区：[1]武警河南总队医院麻醉科,河南郑州450052

出　　处：《湖北民族学院学报（医学版）》2013年第2期29-32,共4页Journal of Hubei Minzu University(Medical Edition)

摘　　要：目的比较临床常用的几种麻醉药物对小儿斜视手术时眼心反射(The oculocardiac reflex,OCR)发生率的影响。方法拟在全麻下行择期斜视纠正术的患者210例,随机分为6组:氯胺酮-异丙酚组(KP组);氯胺酮-瑞芬太尼组(KR组);氯胺酮-七氟醚组(KS组);咪唑安定-异丙酚组(MP组);咪唑安定-瑞芬太尼组(MR组);咪唑安定-七氟醚组(MS组)。采用氯胺酮1mg/kg或咪唑安定0.15mg/kg复合66%氧化亚氮(N2O)诱导。待患者意识消失后给予罗库溴胺0.5mg/kg,继而置入喉罩。麻醉维持KP组和MP组使用异丙酚7～8 mg/(kg.min);KR和MR组则先给予瑞芬太尼首量0.75μg/kg,然后使用66%N2O和瑞芬太尼0.5μg/(kg.min)维持;KS和RS组使用2%～3%的七氟醚维持。结果氯胺酮诱导组中KP组(68.6%)和KR组(65.7%)的OCR发生率明显高于KS组(41.2%)。而咪唑安定诱导组中MP(57.1%)和MR(55.9%)组的OCR发生率亦明显高于MS组(35.3%)。结论小儿斜视手术使用氯胺酮或咪唑安定诱导时,使用七氟醚麻醉与异丙酚和瑞芬太尼相比可以明显减少眼心反射的发生率。Objective To assess the effects of various anesthetic regimens on the incidence of OCR during the surgery.Methods Two hundred and ten children aged from 1 to 9 undergoing e- lective strabismus surgery were randomly assigned to six groups, ketamine-sevoflurane （ KS）, ketamine-propofol （ KP）, ketamine-remifentanil （ KR）, midazolam-sevoflurane （ MS ）, midazo- lam-propofol（MP） ,and midazolam-remifentanil （MR）.No premedication was given. Anesthe- sia was induced using ketamine 1 mg/kg or midazolam 0.15 mg/kg with 66% N20 in O2.Laryn- geal mask airways （LMAs） were placed with rocuronium 0.5 mg/kg.Anesthesia was main- tained with sevoflurane 2%-3%,propofol 7-8 mg/（ kg ~ h）,or remifentanil 0.75 Fg/kg over 1 min, followed by a continuous infusion of remifentanil 0.5 I^g/（kg ~ min） with 66% N20 in 02. Heart rate （HR） was recorded during extraocular muscle （EOM） manipulation.OCR was de- fined as a reduction in HR of more than 20% induced by the traction of an EOM.Reselts In pa- tients given ketamine, OCR occurred more frequently in the KP （68.6%） and KR （65.7%） groups than in the KS （41.2%） group （P〈0.O5）.ln patients given midazolam, OCR occurred more frequently in the MP （57.1%） and MR （61.8%） groups than in the MS （32.4%） group （P 〈0.05）. Conclution Propofol or remifentanil anesthesia was associated with a higher incidence of OCR during pediatric strabismus surgery than sevoflurane anesthesia, when either ketamine or midazolam was used as an induction agent.

关 键 词：眼心反射 斜视手术 麻醉 

分 类 号：R726.1[医药卫生—儿科]