丙泊酚或氯胺酮复合右美托咪定静脉麻醉在小儿先天性心脏病介入封堵术的效果比较  

Comparison of the anesthetic effect of propofol or ketamine combined with dexmetomide in children with congenital heart disease undergoing cardiac catheterization

作　　者：陈小莉[1] 郭仲辉[1] 魏利娟[1] 马亚飞[1] 谭冠先[2] Chen Xiaoli;Guo Zhonghui;Wei Lijuan;Ma Yafei;Tan Guanxian(Clinical Medical College,Henan University of Science and Technology,Department of Anesthesiology,The First Affiliated Hospital of Henan University of Science and Technology,Luoyang 471003,China;Department of Anesthesiology,First Affiliated Hospital of Guangxi Medical University,Nanning 530021,China)

机构地区：[1]河南科技大学临床医学院河南科技大学第一附属医院麻醉科,洛阳471003 [2]广西医科大学第一附属医院麻醉科,南宁530021

出　　处：《广西医科大学学报》2019年第10期1647-1650,共4页Journal of Guangxi Medical University

摘　　要：目的:观察丙泊酚或氯胺酮复合右美托咪定静脉麻醉用于先天性心脏病介入封堵术的麻醉效果。方法:将60例先天性心脏病封堵术患儿按麻醉方法不同分为丙泊酚复合右美托咪定组(P组)和氯胺酮复合右美托咪定(K组),每组30例。记录麻醉前(T1)、麻醉诱导后(T2)、穿刺时(T3)、置封堵器即刻(T4)、苏醒时(T5)的平均动脉压(MAP)、心率(HR)、血氧饱和度(SPO2)和脑电双频指数(BIS)值。以OAA/S镇静评分标准及术中体动次数评估麻醉效果;以改良Steward苏醒评分评估患儿术后麻醉恢复时间,同时记录手术时间、苏醒时间、呼吸抑制、恶心呕吐、苏醒期躁动等不良反应的发生情况。结果:与T1时点比较,T2~T4时点两组BIS值均降低(均P<0. 05);K组在T5时点MAP、HR较T1时点显著升高(P<0. 05),而P组无明显变化(P>0. 05)。两组术中OAA/S镇静评分及体动情况比较,差异无统计学意义(P>0. 05)。K组麻醉恢复时间显著长于P组,苏醒期躁动发生率明显高于P组(P<0. 05)。结论:丙泊酚复合右美托咪定静脉麻醉用于小儿先天性心脏病介入封堵手术的镇静、镇痛效果满意,对苏醒期的血压、HR影响更小,麻醉恢复更快。Objective: To observe the anesthetic effect of propofol or ketamine combined with dexmetomide in children with congenital heart disease undergoing cardiac catheterization. Methods: According to different anaesthesia methods,60 children with congenital heart disease were divided into propofol combined with dexmetomide group(group P)and ketamine combined with dexmetorimidin group(group K),with 30 cases in each group. The mean arterial pressure(MAP),heart rate(HR),oxygen saturation(SPO2)and EEG bispectral index(BIS)were recorded before anesthesia(T1),after anesthesia induction(T2),at puncture time(T3),immediately after occlusive device(T4)and when awakening(T5). The anesthetic effect was evaluated by OAA/S sedation score and the number of body movements during operation,and the postoperative anaesthesia recovery time was evaluated by modified Steward awakening score. The operation time,awakening time and the incidence of adverse reactions such as respiratory suppression,nausea and vomiting,restlessness during recovery were recorded as well. Results: The BIS of both groups decreased at T2 to T4 compared with T1(P<0. 05). In group K,MAP and HR at T5 was significantly higher compared with T1(P<0. 05),but there was no significant change in group P(P>0. 05). There was no significant difference in intraoperative OAA/S sedation score and body movements between the two groups(P>0. 05). The recovery time of anesthesia in group K was longer than that in group P,and the rate of restlessness was higher(P<0. 05). Conclusion: The sedation and analgesic effects of propofol combined with dexmetomide intravenous anesthesia in congenital heart disease children undergoing cardiac catheterization are satisfactory. It has less effect on blood pressure,HR and faster recovery of anesthesia.

关 键 词：丙泊酚 氯胺酮 右美托咪定 先天性心脏病 介入封堵 

分 类 号：R726.1[医药卫生—儿科]