芬太尼或氯胺酮联合丙泊酚在小儿喉罩麻醉中的应用研究  

The comparison of propofol combined with ketamine or fentanyl for laryngeal mask placement application in pediatric patients

作　　者：闵新康[1] 邓小强[1] 张雷[1] 胡健[1] 

机构地区：[1]安徽医科大学第一附属医院麻醉科,安徽合肥230022

出　　处：《安徽医药》2013年第9期1562-1564,共3页Anhui Medical and Pharmaceutical Journal

摘　　要：目的探讨芬太尼或氯胺酮联合丙泊酚在小儿喉罩置入时的理想麻醉诱导方法。方法 60例ASAⅠ～Ⅱ级择期手术拟行喉罩置入的患儿,随机分为芬太尼组(F组,n=30)和氯胺酮组(K组,n=30),两组患儿分别静脉注射芬太尼2μg·kg-1或氯胺酮0.5 mg·kg-1,然后静脉注射丙泊酚3.5 mg·kg-1,90 s后行喉罩(LMA)置入。分别记录LMA置入前的血压(BP)和心率(HR)作为基础值以及LMA插入后1、3、5 min的BP和HR;主观分级并记录LMA置入后抗张口、抗插入、吞咽、咳嗽/作呕、头部和肢体运动、喉痉挛的发生情况;记录LMA置入后呼吸暂停的持续时间和发生率;LMA一次性置入成功率、追加丙泊酚后LMA置入成功率及改气管插管病例数和发生率。结果两组间抗张口、抗LMA置入和吞咽的发生率的差异无显著统计学意义;F组和K组在咳嗽/作呕、肢体/头部运动、呼吸暂停的发生率分别为7%/27%、64%/76%、80%/50%;两组均没有喉痉挛发生。与F组比较,K组在同时点的HR、BP较对照组之间的差异有统计学意义。结论芬太尼(2μg·kg-1)联合丙泊酚较氯胺酮(0.5 mg·kg-1)联合丙泊酚的麻醉诱导方法,能提供较好的的小儿LMA置入条件和较低的不良反应发生率。Objective To investigate ideal combination of propofol combined with ketamine or fentanyl for laryngeal mask placement ap-plication in pediatric patients. Methods Sixty pediatric patients of ASA Ⅰ - Ⅱ undergoing elective surgery for laryngeal mask place-ment were randomly assigned into fentanyl group （group F,n = 30） and ketamine group（ group K,n = 30）. Anesthesia induction： After intravenous injection fentanyl 2 μg · kg ^- 1 （ group F） or ketamine 0.5mg·kg^-1 （ group K）, intravenous injection of propofol 3.5 mg·kg^-1, and then laryngeal mask （LMA） was inserted. Blood pressure （BP） and heart rate （HR） at based values before LMA placement at 1,3,5 minutes after LMA insertion were recorded. Subjective grading of LMA placement of resistance open mouth and insert, swallo-wing, cough/sick, head and body movement, laryngospasm were recorded;the duration and morbidity of apnea after LMA placement were recorded;the success rates, additional propofol and endotracheal intubation number were also recorded. Results The incidence rate of resistance open mouth and insert,swallowing had no statistically significant differences between group F and group K.The incidence rate of cough/sick,body/head movement,apnea were 8% and 28% ,64% and 76% ,50% and 80% in group F and group K respectively. In group F and group K the incidences of apnea were 80% and 50% respectively. Compared with group F, the HR, systolic blood pressure （SBP） ,diastolic blood pressure （DBP） ,mean arterial pressure （MBP） in the same time is higher than those in group K. Conclusions Fentanyl （2μg ·kg^-1） combined with propofol （3.5 mg·kg^-1） can provide the better condition of LMA placement than ketamine （0.5 mg·kg^-1 ） combined with propofol in pediatric patients.

关 键 词：氯胺酮 芬太尼 丙泊酚 小儿 喉罩 

分 类 号：R726.1[医药卫生—儿科]