氯胺酮复合右美托咪定在小儿烧伤非插管麻醉中的应用  

Application of ketamine combined with dexmedetomidine anesthesia in pediatric burns with non-intubation

作　　者：刘敏肖[1,2] 王勇 李燕[1,2] 宋子贤 董亚静[1] LIU Min-xiao;WANG Yong;LI Yan;SONG Zi-xian;DONG Ya-jing(Department of Anesthesiology,Hebei Hospital of Traditional Chinese Medicine,Shijiazhuang HEBEI 050011,China;Department of Anesthesiology,Youai Hospital of Hebei,Shijiazhuang HEBEI 050031,China;Department of Anesthesiology,the Forth Hospital of Hebei Medical University,Shijiazhuang HEBEI 050019,China)

机构地区：[1]河北省中医院麻醉科,河北石家庄050011 [2]河北友爱医院麻醉科,河北石家庄050031 [3]河北医科大学第四医院麻醉科,河北石家庄050019

出　　处：《中国新药与临床杂志》2020年第3期166-168,共3页Chinese Journal of New Drugs and Clinical Remedies

基　　金：中医药科研计划项目(2020059)。

摘　　要：目的观察氯胺酮复合右美托咪定在小儿烧伤手术中的应用效果。方法择期行手术的烧伤患儿40例,随机均分为2组。均给予氯胺酮1~2 mg·kg^-1麻醉诱导,对照组以丙泊酚3~4μg·kg^-1·h^-1持续泵注,试验组予右美托咪定1μg·kg^-1负荷量后以0.5μg·kg^-1·h^-1维持泵注;均根据肢动情况间断静脉注射氯胺酮维持。监测心率(HR)、平均动脉压(MAP)和脉搏氧饱和度(SpO2),观察并记录手术时间、苏醒时间、呼吸抑制和躁动发生情况,评估Ramsay镇静评分。结果2组手术时间、术中输液量、苏醒时间无显著差异(P>0.05)。试验组手术开始前、手术开始后2 min、术毕、苏醒时的HR和MAP水平均低于入室时,且低于同时点对照组(P<0.05)。与对照组比较,试验组苏醒期躁动评分低(P<0.05),术后2 h镇静评分高(P<0.05),术中呼吸抑制发生率低(5%vs.25%,P<0.05)。结论氯胺酮复合右美托咪定应用于小儿烧伤手术非气管插管麻醉安全、有效,效应优于氯胺酮复合丙泊酚。AIM To investigate the effect of ketamine combined with dexmedetomidine anesthesia in pediatric burned patients.METHODS Forty pediatric burned patients undergoing surgery were randomly divided into two groups.All of patients were induced by ketamine 1-2 mg·kg^-1,then maintained by propofol 3-4μg·kg^-1·h^-1 in the control group.And dexmedetomidine 1μg·kg^-1 was infused for 10 minutes and maintained by 0.5μg·kg^-1·h^-1 in the experimental group.Additional ketamine was infused based on limb movement in two groups.Heart rate(HR),mean arterial pressure(MAP),pulse oxygen saturation(SpO2)were monitored and recorded during the operation.Time of operation,respiratory depression,awakening time,awakening period agitation and the Ramsay score of 2 hours after operation were observed.RESULTS There were no statistical significance differences in operation time,infusion quantity,awakening time between the two groups(P>0.05).Compared with those at entering the operation room,MAP and HR group were lower before the operation,2 minutes after the operation,end of the operation,awakening time in the experimental group,and were lower than those of the control group at the same time(P<0.05).Compared with those in the control group,the score of awakening period agitation was lower in the experimental group(P<0.05),and the Ramsay score at 2 hours after operation was higher(P<0.05).The incidence of respiratory depression was lower in the experimental group than that in the control group(5%vs.25%,P<0.05).CONCLUSION Ketamine combined with dexmedetomidine is effective and safe in pediatric burned patients with non-intubation anesthesia,and superior to ketamine combined with propofol.

关 键 词：氯胺酮 右美托咪定 儿童 烧伤 

分 类 号：R969[医药卫生—药理学]