瑞芬太尼—氯胺酮静脉复合全麻在小儿隐睾固定术中的应用

目的探讨瑞芬太尼—氯胺酮静脉复合全麻用于小儿隐睾固定手术的可行性。方法将40例ASAⅠ～Ⅱ级择期行小儿隐睾固定术的患儿随机分为瑞芬太尼联合氯胺酮组(R组)和氯胺酮组(L组),各20例。L组于切皮前2min给予氯胺酮2mg/kg静脉注射后手术;R组于切皮前2min给予瑞芬太尼0.5μg/kg,静脉注射后用微量输液泵泵入瑞芬太尼6μg·kg-1·h-1,静脉注射氯胺酮2mg/kg后手术,术中依需要静脉注射氯胺酮加深麻醉。比较2组麻醉效果、呼吸与循环的变化、氯胺酮的用量及苏醒时间。结果 2组均获良好麻醉效果;R组血压和心率稳定,L组平均动脉压和心率升高(P<0.05),R组麻醉后各时点平均动脉压及心率均低于L组(P<0.01)。R组较L组易引起呼吸抑制。R组氯胺酮的用量为(54.0±13.8)mg少于L组的(82.0±17.6)mg(P<0.01),R组停药至苏醒时间为(10.3±3.4)min短于L组的(23.1±9.6)min(P<0.05)。结论瑞芬太尼—氯胺酮静脉全麻疗效确切,苏醒快而完全,可用于小儿隐睾固定手术。

Application of remifentanil combined with ketamine intravenous anesthesia in children with cryptorchidism surgery

Objective To investigate the feasibility of remifentanil combined with ketamine intravenous anesthesia in children with cryptorchidism surgery. Methods 40 cases of ASA I Ⅱ level in children with cryptorchidism undergoing elective surgery were randomly divided into remifentanil combined with ketamine group（ L group） and ketamine group（ R group）, each of 20 cases. 2min before skin incision, L group were given ketamine 2mg/kg, then started surgery; R group were given remifentanil 0.5 μg/kg, after infusion pump micro pump remifentanil 6μg·kg-1·h-1 intravenous, injection of ketamine 2mg/ kg, then started surgery, according to the needs of intraoperative intravenous ketamine anesthesia deepened. Compared anesthet- ic effect, breathing and circulation changes in the amount of ketamine and the recovery time of two groups. Results Two group had a good anesthetic effect. Blood pressure and heart rate of R group stabilized, MAP and heart rate of L group increased （P 〈 0. 05 ）, after anesthesia MAP and heart rate at each time point of R group were lower than those of L group（ P 〈 0. O1 ）. R group easily caused respiratory depression. Ketamine dosage of R group （54.0 ± 13.8 ） mg was less than that of L group （82.0± 17.6） mg （ P 〈 O. O1 ）, withdrawal to recovery time of R group （ 10.3 ± 3.4） min was shorter than that of L group （23.1 ± 9.6 ） rain （ P 〈 0.05 ）. Conclusion Remifentanil combined with ketamine intravenous anesthesia is effective, fast and totally awake, can be used for children with cryptorchidism surgery.