氯胺酮联合咪达唑仑直肠内灌注作为先天性心脏病患儿术前用药的临床观察

目的探讨氯胺酮联合咪达唑仑直肠内灌注作为先天性心脏病患儿术前用药方法的可行性、效果及安全性.方法先天性心脏病患儿45例,随机均分为3组：KMR组：术前30 min直肠内灌注氯胺酮5 mg/kg＋咪达唑仑0.5 mg/kg＋阿托品0.02 mg/kg;MR组：术前30 min直肠内灌注咪达唑仑0.5 mg/kg＋阿托品0.02 mg/kg;MO组：术前30 min口服咪达唑仑0.5 mg/kg.结果 3组间患儿对药物的接受程度、药物抗焦虑和镇静效果及用药后的脉搏、呼吸频率及血氧饱和度的差异均无显著性.KMR组的外周静脉穿刺成功率为100.0%,显著高于MR组的66.7%和MO组的73.3%（P值均＜0.05）.结论直肠内联合应用氯胺酮的镇痛作用优于单独应用咪达唑仑.氯胺酮联合咪达唑仑直肠内灌注作为先天性心脏病患儿的术前用药安全、可行、有效.

A clinical trial of ketamine and midazolam as rectal premedication for preoperative child with congenital heart disease

Objective To Assess the possibility, safety and efficacy of ketamine and midazolam as rectal premedication for children undergoing cardiac surgery. Methods 45 children aged between 6 months and 5 years undergoing congenital heart disease surgical operation were randomly assigned in 3 groups : Group KMR(15 cases): ketamine 5 mg/kg, midazolam 0.5 mg/kg and atropine 0.02 mg/kg via rectum 30 minutes before incharging . Group MR: midazolam 0.5 mg/kg and atropine 0.02 mg/kg via rectum 30 minutes before incharging. Group MO: Oral taking midazolam 0.5 mg/kg before incharging. Results There were no differences in the 3 groups for anti-anxiety, sedation effects and acception of medication. There were no differences in pulse rate, respiratory rate and SpO_2 in the 3 groups. Group KMR had a better analgesic effect, the successful cannulation of peripheral vein seemed better than the other two groups (P<0.05). Conclusions Ketamine combined with midazolam as rectal premedication is a safe and effective way for children undergoing operation with congenital heart disease.