低龄小儿简骶麻两种静脉辅助方法的临床疗效比较

摘 要 目的:通过对两种静脉浅全麻辅助方法疗效的比较,以往推荐较优越的一种。方法:选择即将进行腹股沟或会阴区手术的低龄小儿(2～6岁)60例,并随机分成简骶麻加异丙酚芬太尼组(PFS组,n=30)和简骶麻加咪唑安定氯胺酮麻醉组(DKS组,n=30)。前组于小儿入室后即行简骶麻醉,完成操作后再注射芬太尼和丙泊酚静脉诱导,持续微泵丙泊酚维持;后组则简骶麻后,用氯胺酮和咪唑安定诱导,静脉泵注氯胺酮维持。观察记录麻醉前后平均动脉压(MAP)、心率(HR)、呼吸频率(R)、脉搏氧饱和度(SPO.2)的变化程度以及术后苏醒时间,术中术后躁动、呕吐等不良反应的发生率。结果:两组小儿的一般情况、麻醉前生命体征及手术时间差异均无显著性,麻醉后1、5、10、15分钟分别与麻醉前相比,PFS组和DKS组的MAP、SPO.2均差异无显著性,而HR及R均呈显著性变化(P

关键词 低龄小儿 两种辅助麻 疗效 比较

doi:10.3969/j.issn.1007-614x.2010.22.133

AbstractObjective:To recommend a better treatment by comparing 2 Intravenous Use of Mild General Anesthetics.Method:60 young (2～6) patients intending for inguinal or perineum operation were selected and divived into caudal anesthesia propofol and fentanyl added group (PFS group, n=30) and caudal anesthesia midazolam ketaminge group (DKS group, n=30). The former group of children were pilo anesthetized and injected with fentanyl and propofol intravenous induction,with fentanyl in micropump maintained continuously; the latter group were induced via midazolam and ketamine after caudal anesthesia, with ketamine maintained continuously. Change degree and postoperative recovery time of preoperative and postoperative Average arterial pressure (MAP), heart rate (HR), respiratory rate (R), pulse oximetry (SPO.2) as well as incidence of reverse reaction including intraoperative and postoperative restlessnes, vomiting were observed and recorded. Compared with that before anesthesia, both MAP and SPO.2 in PFS group and DKS group were not remarkably different 1, 5, 10, 15 min. after anesthesia with remarkable differences in HR and R (P

Key WordsYoung Children;2 Assisted Anesthesia;Curative Effect;Comparison

简单骶麻具有操作简单,对呼吸循环影响小等优点,被广泛应用于低位区域手术的麻醉。但由于小儿不合作的心理和生理等因素,除了局部麻醉以外,还必须辅以浅全麻。

我科自2006年起至今,共施行小儿骶麻100余例,其中的低龄小儿(2～6岁)均采用了氯胺酮复合咪唑安定或丙泊酚复合芬太尼静脉强化辅助。

现随机各抽取30例进行麻醉疗效比较,发现丙泊酚复合芬太尼辅助组效果更为理想。详细报告如下。