阈下剂量氯胺酮对小儿七氟烷全麻苏醒期躁动的影响  

Effect of subthreshold dose of ketamine on agitation during general anesthesia of sevoflurane in children

作　　者：曾毅 李忠云 高国一 陈小军 Zeng Yi;Li Zhongyun;Gao Guoyi(Anesthesiology Department, People's Hospital of Xishuangbanna Dai Autonomous Prefecture, Jinghong,Yunnan 666100,China)

机构地区：[1]西双版纳傣族自治州人民医院麻醉科

出　　处：《云南医药》2019年第2期109-112,共4页Medicine and Pharmacy of Yunnan

摘　　要：目的 观察阈下剂量氯胺酮对小儿七氟烷全麻后苏醒期躁动的影响。方法 选取2018年1月-2018年5月择期行浅表手术的小儿48例,采用随机数表法分为SF组和KM组,使用七氟烷吸入诱导,SF组在诱导后给予舒芬太尼0.1μg/kg,KM组在SF组基础上加用0.25mg/kg氯胺酮,术中以丙泊酚和七氟烷吸入维持麻醉,术后送PACU观察,记录2组患儿的一般情况、手术麻醉时间;苏醒期FLACC疼痛评分、Ramsay镇静评分及苏醒期躁动评分、PACU滞留时间及术后恶心呕吐、嗜睡、精神症状等不良反应发生率。结果 与SF组比较,KM组在苏醒后Ramsay镇静评分较高及躁动评分较低(P<0.05),在FLACC疼痛评分及PACU滞留时间上无统计学意义(P>0.05);SF组恶心呕吐发生率>与KM组(P<0.05),在术后嗜睡、精神症状发生率上2组患儿比较无统计学意义(P>0.05)。结论 术前给予阈下剂量氯胺酮0.25mg/kg能显著降低术后躁动的发生率,改善苏醒后的镇静评分,且不良反应恶心呕吐发生率低,值得临床使用。Objective To observe the effect of subthreshold dose of ketamine on the agitation of sevoflurane after general anesthesia in children.Methods 48 children with elective superficial surgery from January 2018 to May 2018 were selected and divided into SF group and KM group by random number table method,Inhaled sevoflurane was induced, SF group was given sufentanil 0.1μg/kg after induction, KM group was supplemented with 0.25mg/kg ketamine based on SF group, and anesthesia was maintained by inhalation with propofol and sevoflurane during operation,sent to PACU for observation after surgery.Record the general condition, operation and anesthesia time of the two groups;FLACC pain score during recovery, Ramsay Sedation score and recovery period agitation score, PACU retention time and postoperative nausea and vomiting, lethargy, mental symptoms and other adverse reactions.Results Compared with the SF group, the Ramsay sedation score was higher and the agitation score was lower in the KM group (P<0.05), there was no statistically significant difference in FLACC pain score and PACU retention time (P>0.05);the incidence of nausea and vomiting in SF group was higher than that in KM group (P<0.05), postoperative sleepiness, spirit There was no significant difference in the incidence of symptoms between the two groups (P>0.05).Conclusion Preoperative subthreshold dose of ketamine (0.25mg/kg) can significantly reduce the incidence of postoperative agitation, improve the sedation score after recovery, and the incidence of adverse reactions of nausea and vomiting is low, which is worthy of clinical use.

关 键 词：七氟烷 氯胺酮 术后躁动 恶心呕吐 

分 类 号：R614.2[医药卫生—麻醉学]