异丙酚复合氯胺酮、利多卡因静脉麻醉在小儿小手术中的应用

目的比较异丙酚复合氯胺酮、利多卡因静脉麻醉与氯胺酮静脉麻醉用于小儿小手术的安全性、可行性。方法选择ASAⅠ~Ⅱ级患儿50例,随机分为两组:氯胺酮组(K组)和异丙酚复合氯胺酮、利多卡因组(C组),每组25例。麻醉诱导:K组给予氯胺酮2.0 mg/kg;C组给予异丙酚、氯胺酮、利多卡因混合液(异丙酚60 mg、氯胺酮100 mg、利多卡因40 mg配制成总量10 mL的混合液,简称PKL)0.2 mL/kg,均在1 min内匀速静注。麻醉维持:K组用氯胺酮2.0~4.0 mg/(kg.h)微量泵恒速输注,C组用PKL混合液0.2~0.4mL/(kg.h)微量泵恒速输注,根据手术刺激增减药物剂量。术中保留自主呼吸,面罩给氧,术毕停用药。结果K组麻醉后MAP和HR较麻醉前升高(P<0.05);C组麻醉后MAP和HR变化不显著(P>0.05);两组SPO2比较无显著性差异(P>0.05);清醒时间C组明显快于K组(P<0.05),术后躁动及恶心、呕吐发生率C组明显低于K组(P<0.05)。结论异丙酚复合氯胺酮、利多卡因静脉麻醉较氯胺酮静脉麻醉更平稳,术后清醒快,更适合小儿短小手术。

Application of Propofol Combined Ketamine and Lidocaine Intravenous Anesthesia in Short Pediatric Operations

Objective To compare the safety and feasibility of propofol combined with ketamine and lidocaine intravenous anesthesia with ketamine intravenous anesthesia in short pediatric operation.Methods Fifty children ASAⅠ～Ⅱ,aged 3-11,were randomly devided into two groups;the group of ketamine(K)(n=25) and the group of propofol combined with ketamine and lidocaine(C)(n=25).Anesthetic induction:Ketamine 2 mg·kg~(-1) was infused in group K and mixed liquor of propofol combined with ketamine and lidocaine(PKL) 0.2 mL·kg~(-1) in group C in one minutes.Anesthetic maintance:Ketamine was administerd by pumping at the rate of 2～4 mg/(kg·h)~(-1) in group K and PKL mixed liquor 0.2～0.4 mL/(kg·h)~(-1) in group C,and.Results There was a significant increase in MAP and HR in group K(P<0.05),and there was no significant difference in group C(P>0.05).There was no significant difference in SPO_2 between two group(P>0.05).Conscious time was shorter in group C than group K(P<0.05).Incidence of postoperative restlessness and nausea and vomiting was lower in group C tha group K(P<0.05).Conclusion Compared with ketamine intravenous anesthesia,propofol combined ketamine and lidocaineintravenous anesthesia is more steady and faster to awake after operation and more suitable to short pediatric operation.