氯胺酮和异丙酚对小儿眼内压的影响  

Effects of anesthesia with ketamine or propofol on intraocular pressure in pediatric patients

作　　者：吴蓉蓉[1] 戴秀萍[1] 张家东[2] 

机构地区：[1]安徽医科大学第一附属医院麻醉科,合肥230022 [2]安徽省六安市妇幼保健院,237000

出　　处：《安徽医科大学学报》2001年第1期33-35,共3页Acta Universitatis Medicinalis Anhui

摘　　要：目的　观察静脉麻醉药氯胺酮和异丙酚对小儿眼内压的影响。方法　选择ASAⅠ～Ⅱ级患儿 2 7例 ,分为氯胺酮组和异丙酚组。肌注氯胺酮 4～ 6mg·kg-1和氟哌利多0 0 4～ 0 1mg·kg-1基础麻醉后 ,氯胺酮组单次静注氯胺酮1mg·kg-1,继之静滴 0 .0 4%氯胺酮 ,必要时间断追加氯胺酮 ;异丙酚组单次静注异丙酚 1mg·kg-1,继之静滴 0 0 4%异丙酚 ,必要时间断追加异丙酚和氯胺酮。分别于基础麻醉后 10min、单次静注氯胺酮和异丙酚 3min及手术结束后测眼内压 ,并监测收缩压 (SBP)、舒张压 (DBP)、心率 (HR)和脉搏血氧饱和度 (SpO2 )。结果　两组患儿基础麻醉后眼内压无差异 ,单次静注氯胺酮眼内压升高 ,单次静注异丙酚则眼内压下降 (P <0 0 5 ) ;手术结束后 ,氯胺酮组眼内压下降 ,与异丙酚组差异无统计学意义。基础麻醉后至手术结束 ,SBP、DBP、HR变化两组间差异无统计学意义。静注氯胺酮后 5min内 ,SpO2 其中 1例 <95 % ,余无下降 ,静注异丙酚后5min内 ,SpO2 下降与基础麻醉后比差异有统计学意义 ,其中 3例 <95 %。结论　单纯静注氯胺酮可升高眼内压 ,静注异丙酚降低眼内压 ,两者复合应用可避免眼内压升高 ,但呼吸抑制作用增强。Objective To observe the influence of intravenous anesthesia with ketamine or propofol on intraocular pressure (IOP) in pediatric patients. Methods 27 pediatric patients, ASA grade Ⅰ～Ⅱ, were divided into ketamine and propofol groups. Basic anesthesia was conducted with ketamine 4～6 mg·kg -1 combined droperidol 0.04～0.1 mg·kg -1 intramuscularly. Anesthesia maintained with continous infusion of 0.04% ketamine or 0.04% propofol following intravenous bolus of ketamine 1 mg·kg -1 or propofol 1 mg·kg -1 in ketamine group and propofol group respectively. IOP, systemic blood pressure(SBP), diastolic blood pressure(DBP), heart rate(HR) and pulse oxygen saturation(SpO 2) were measured at 10 minutes after basic anesthesia, 3 minutes after intravenous bolus of ketamine or propofol and end of surgery. Results There were no differences in IOP between two groups after basic anesthesia. IOP increased or decreased significantly after intravenous bolus of ketamine or propofol respectively. IOP in ketamine group decreased near to the level in propofol group at end of surgery. There were no statistic differences in SBP, DBP and HR between two groups priopration. SpO 2 did not change (but in one patient decreasing to below 95% ) and significantly decreased within 5 minutes of intravenous bolus of ketamine and propofol respectively. Conclusion Ketamine increases IOP propofol decreases IOP. Ketamine combined propofol can keep from increase of IOP but strength respiration inhibition.

关 键 词：氯胺酮 药理学 二异丙酚 眼内压 药物作用 

分 类 号：R775[医药卫生—眼科] R971.2[医药卫生—临床医学]