复方氯胺酮口服液用于小儿术前的药效观察  

Oral ketamine compounds for premedication in children

作　　者：张锦[1] 韩盛[1] 丁平田[2] 崔健君[1] 张秉钧[1] 

机构地区：[1]中国医科大学附属二院麻醉科,沈阳110004 [2]沈阳药科大学药剂教研室

出　　处：《中华麻醉学杂志》2003年第6期412-415,共4页Chinese Journal of Anesthesiology

基　　金：辽宁省自然科学基金资助课题(20022074)

摘　　要：目的 通过对小儿术前服用不同剂量复方氯胺酮口服液进行药效学观察.选出最佳小儿术前用药。方法 选ASA Ⅰ～Ⅱ级择期小儿泌尿外科手术患儿75例,体重10～30 kg.随机分5组:C组:空白对照组,不用镇静药,阿托品(AT)0.015 mg·kg-1术前30 min肌注;DA组(安定+AT):传统对照组,安定0.2mg·kg-1+AT 0.015mg·kg-1术前30min肌注;K3MA组(氯胺酮3mg·kg-1、咪达唑仑0.5mg·kg-1、AT 0.03 mg·kg-1)、K5MA组(氯胺酮5 mg·kg-1、咪达唑仑0.5mg·kg-1、AT 0.03mg·kg-1)、k8MA组(氯胺酮8 mg·kg-1、咪达唑仑0.5mg·kg-1、AT 0.03 mg·kg-1)术前30 min 0.25 ml·kg-1口服,评估用术前药后对患儿镇静、情绪状态、与父母分离和静脉穿刺时的行为的影响及术后神经行为的变化。结果 (1)KMA三组口服10～50 min显效,k8MA最快,K3MA最慢,k5MA位于两者之间;(2)KMA三组镇静、镇痛及术后睡眠质量明显优于对照组(P<0.05)。KMA三组间又有明显差异,K3MA明显劣于k5MA、K8MA(P<0.05)。K8MA的镇静效果虽好,但部分患儿服药后出现复视、头痛和明显的精神兴奋症状。结论 K5MA镇静、止痛效果与K8MA相近,其副作用低于K8MA,因此,K5MA是较理想的小儿术前用药。Objective Intramuscular ketamine is often used for premedication in children. Premeditation can also be administered perorally in children. The aim of this study was to evaluate the efficacy of different compounds of ketamine given perorally as premedication in children. Methods Seventy-five ASA Ⅰ- Ⅱ pediatnc patients weighing 10-30 kg undergoing urologic operation were randomly divided into 5 groups of 15 patients each : (1) control group received atropme 0.015 mg · kg-1 im 30 min before surgery; (2) DA group received intramuscular diazepam 0.2 mg·kg-1 and atropine 0.015 mg·kg-1 30 min before operation; (3) (4) (5) KMA groups received ketamine 3 mg·kg-1 (K3MA) or5mg·kg-1 (K5MA) or 8mg·kg-1 ( K8 MA) + midazolam 0.5 mg·kg-1 + atropine 0.03 mg·kg per os 30 min before operation. SpO2 and heart rate (HR) were monitored and recorded before premedication and at 0, 5, 10, 15, 20, 30 and 40 min after premedication. Peak effect time, duration of operation and emergence time were also recorded. Sedation, anxiolysis and behaviour at separation from parents, during venepuncture and induction were graded and assessed. Results There was no significant difference in duration of operation among the five groups. The peak effect time in the three KMA groups was shorter than that in control and DA group and was shortest in K8MA group. The three KMA groups were significantly better than control and DA group and the K8 MA group was the best in terms of sedation, anxiolysis and analgesia. The incidence of adverse effects like diploplia headache and agitation was higher in K8MA group. Conclusion K5MA group provides satisfactory sedation and analgesia similer to Kg MA group with less side-effects, so is the oral ketamine compound of choice for premedication in children.

关 键 词：小儿外科手术 复方氯胺酮口服液 咪达唑仑 麻醉前用药 给药途径 

分 类 号：R96[医药卫生—药理学]