臂丛阻滞复合氯胺酮麻醉在小儿上肢手术中的应用

目的：观察罗哌卡因臂丛神经阻滞复合氯胺酮-丙泊酚静脉麻醉在小儿上肢手术中应用，对呼吸循环功能以及术后恢复情况的影响。方法：50例行上肢手术患儿随机分为两组：氯胺酮基础麻醉后，臂丛神经阻滞复合氯胺酮-丙泊酚静脉麻醉组（A组，n=25），臂丛阻滞成功后注入0．25％罗哌卡因0．5ml／kg，术中以氯胺酮-丙泊酚持续静注；单纯氯胺酮-丙泊酚静脉麻醉组（B组，n=25），术中氯胺酮-丙泊酚持续静注。结果：术中A组循环、呼吸功能较B组稳定（P〈0．05）；肢体不良自主运动，喉痉挛等不良反应较B组少（P〈0．05）；A组氯胺酮用量明显少于B组（P〈0．01）；术后A组苏醒较快且平稳。恢复期精神症状少，与B组比较有显著差异（P〈0．05）。结论：臂丛神经阻滞复合氯胺酮-丙泊酚静脉麻醉应用于小儿上肢手术，可减少氯胺酮用量从而减少其不良反应，使患儿在麻醉手术期间呼吸循环更平稳，家长及医护人员满意度明显提高。

The Application of Plexus Brachialis Nerves Block Combined with Intravenous Anesthesia used in the Operation of Children's arm

Objective： Observing the effect of breath and circulation and recovery of the arm operation when using the ropivacaine plexus brachialis nerves block combined with ketamine - propofol intravenous anesthesia. Method： Fifty children undergoing arm operation were randomly divided into two groups：After ketamine based anesthesia,Plexus brachialis nerves block combined with ketamine - propofol intravenous anesthesia （ group A, n = 25 } , O. 25% ropivacaine O. 5ml/kg was injected to plexus brachialis, ketamine - propofol was injected intravenous connected during the operation;Ketamine - propofol intravenous anesthe- sia { group B, n = 25 ）, ketamine - propofol was injected intravenous connected. Result ： The breath and circulation in group A is more steadily than those in group B during the operation （ P 〈 O. 05 }. The incidence of body movement and larynx spasm is higher in group B （ P 〈 0.05 ）. The quantity of ketamine is less in group A than group B. The recovery is faster and more steadily in group A. which is obviously difference of group B （P 〈 0.05）. Conclusion： Plexus brachialis nerves block combined with ketamine - propofol intravenous anesthesia used in the operation of children＇ s arm can decrease the quantity of ketamine to reduce the un- comfortable response. In this way, the children ＇ s breath and circulation is more steadily during the anesthesia and operation. The parents and doctors＇ satisfactory are highly increased.