氯胺酮复合右美托咪定用于小儿疝修补术前麻醉用药的临床效果观察  

Clinical effect of Ketamine combined with dexmedetomidine for premedication in children with Hernia

作　　者：帅建忠 郭浪涛 杨平亮[2] 

机构地区：[1]成都市妇女儿童中心医院麻醉科,四川成都610041 [2]四川大学华西第二医院麻醉科,四川成都610041

出　　处：《西部医学》2014年第6期728-730,共3页Medical Journal of West China

基　　金：四川省卫生厅科研资助项目(120247)

摘　　要：目的探讨氯胺酮复合右美托咪定用于小儿疝修补术术前用药的临床有效性和安全性。方法选择择期行小儿疝修补手术的患儿70例,随机分为氯胺酮组(K组,氯胺酮6mg/kg口服)与氯胺酮复合右美托咪定组(KD组,氯胺酮6mg/kg口服+右美托咪定2μg/kg滴鼻)各35例。记录滴鼻前(T0)及用药后10min(T10)、20min(T20)、30min(T30)时的心率(HR)、脉搏氧饱和度(SpO2)和根据镇静评分表(sedation scale,SS)评估用药后10、20、30min时的镇静状态,记录评分和患儿入睡时间、拔管时间、苏醒时间。用药30min后根据情绪状态评分表(emotional state scores,ESS)评估患儿与父母分离进入手术室的情绪状态以及对外周静脉穿刺置管的反应。结果 KD组患儿入睡时间比K组患儿短,T30时镇静状态明显优于K组(P<0.05);且KD组患儿与父母分离时情绪状态及静脉穿刺评分明显低于K组(P<0.05);KD组患儿术后恶心、呕吐及精神异常情况也明显少于K组(P<0.05)。结论氯胺酮复合右美托咪定可以使患儿安静的与父母分离,是理想的小儿术前用药。Objective To compare the effect and security of ketamine on ketamine with or without dexmedetomidine for premedication in children with hernia.Method 70 pediatric patients with age 3 to 8 and ASA status Ⅰ[-Ⅱ undergoing hernia operation were randomly divided to two groups including group Ⅰ （K group,ketamine p.o with 6 mg/kg 30 min before undergoing surgery） and group Ⅱ] （KD group,ketamine p.o with 6 mg/kg and dexmedetomidine nasal dripping with 2 μg/kg before undergoing surgery）.HR,SpO2 and sedation scale （SS） were recorded at 10 min （T10）,20min （T20） and 30 min （T30） after application of medicine.The time for sleep,time of extubation and the recovery time from sleep were also recorded.Emotional state scores （ESS） was used to evaluate pediatric patients＇ emotional state when they were separated from their parents and their reaction during venepucture.Results The mean time in need for sleep in KD group was shorter than that in K group,while the sedation level in KD group at T30 were better than that in K group （P〈0.05）.ESS at separation from parents and during venepuncture was lower in KD group than in K group （P〈0.05）.There were also lower adverse effects in KD group than that in K group （P〈0.05）.Conclusion It is a good choice that ketamine combined with dexmedetomidine used as the premedication for pediatric patient operation.

关 键 词：右美托咪定 氯胺酮 术前用药 儿童 

分 类 号：R614[医药卫生—麻醉学]