右美托咪定复合氯胺酮在日间小儿手术中的应用  

Application of dexmedetomidine-ketamine combined anesthesia in pediatricday surgery

作　　者：谢婧[1] 章玲宾[1] 樊理华[1] 

机构地区：[1]丽水市人民医院,浙江丽水323000

出　　处：《浙江医学教育》2017年第1期54-56,63,共4页Zhejiang Medical Education

基　　金：浙江省医学会临床科研项目(编号:2010ZYC-A48)

摘　　要：目的:研究右美托咪定复合氯胺酮在日间小儿手术应用的麻醉效果及安全性。方法:选择70例择期行日间手术的患儿,随机分为对照组和实验组,各35例。对照组采用丙泊酚复合氯胺酮麻醉;实验组采用右美托咪定复合氯胺酮麻醉。持续监测心率(HR)、平均动脉压(MAP)、呼吸频率(RR)、脉搏血氧饱和度(SpO2)、呼气末二氧化碳分压(PETCO2)指标,并记录术后睁眼时间及定向力恢复时间、疼痛视觉模糊评分(VAS)、不良反应发生的情况及术中氯胺酮用药总量。结果:实验组患儿麻醉前后RR、SpO2、PETCO2无明显变化(P>0.05)。对照组患儿麻醉后RR(17±2)次/min、SpO2(92.1±5.6)%明显下降(P<0.05),而PETCO2(29±6)mmHg升高(P<0.05),且其中8例发生呼吸抑制,有9位患儿发生明显低血压,并术后有6位患儿发生躁动,2组差异有统计学意义(P<0.05)。实验组术后睁眼时间(14.4±5.3)min及定向力恢复时间(22.4±9.6)min短于对照组,术中氯胺酮用药总量2组无差异(P>0.05)。结论:右美托咪定复合氯胺酮用于日间小儿术的麻醉效果确切。血流动力学稳定,无明显呼吸抑制,安全系数高,是一种较理想的日间手术麻醉方法。[ Objective] To study the efficacy and safety of dexmedetomidine - ketamine comb＇marion for anesthesia in pediatric day surgeries. [ Method ] Seventy children undergoing day surgery were divided as equal as into two groups randomly. Dexmedetomidine- ketamine was used in experimental group to anesthesia and control group were treated with propofol - ke- tamine. For each case, heart rate （HR）, mean artery pressure （ MAP ）, respiratory rate （ RR ）, pulse oxygen saturation （SpO2） and end - tidal carbon dioxide （PETCO2） were continuously monitored. The eye opening time, orientation recovery time after discontinuing anesthesia, VAS pain score after surgery, adverse reactions and intraoperative ketamine consumption were also recorded. [ Result ] RR, SpO2 or PETCO2 were stable during anesthesia in experimental group （ P 〉 0.05）. Compared with the baseline values before inductions of anesthesia, RR （ 17 ± 2 beats/min） and SpO2 （92.1 ± 5.6% ） in control group were signif- icantly decreased after anesthesia （P〈 0.05）. By contrast, PETCO2 （29 ± 6mmHg） was obviously increased （P〈 0.05）. Fur- thermore, in control group, respiratory depressions were observed in eight patients. There are nine patients with significant hy- potension and six patients with postoperative agitation. Two group of comparison differences have statistics significance （P 〈 0. 05）. Nevertheless, the eye opening time（ 14.4 ± 5.3min） and orientation recovery time（22.4 ± 9.6min） control group werelonger than that of experimental group, had There was no significant difference in Ketamine during the operation （P 〉 0.05）. [ Conclusion] It＇s a kind of ideal anesthesia method in the day surgery with stability hemodynamic, with no obvious respiratory depression and high safety coefficient.

关 键 词：右美托咪定 氯胺酮 小儿手术 

分 类 号：R614[医药卫生—麻醉学]