复合小剂量芬太尼在氯胺酮-丙泊酚小儿静脉全身麻醉中的效果

目的观察小剂量芬太尼在氯胺酮-丙泊酚小儿静脉全身麻醉的效果,为临床麻醉方案的选择提供参考。方法选取接受手术治疗的患儿78例,随机分为观察组和对照组各39例。对照组采用氯胺酮-丙泊酚复合麻醉,观察组采用小剂量芬太尼复合氯胺酮-丙泊酚麻醉。对比两组患儿麻醉过程中的心率(HR)、呼吸次数(RR)、血氧饱和度(Sp O2)和术后苏醒的情况,同时采用11点数字评分法评估患儿术后24 h的疼痛情况。结果麻醉后5 min、麻醉后10 min,两组患儿的RR、HR均显著高于麻醉前(均P0.05),而麻醉前后Sp O2的对比,差异均无统计学意义(P0.05);观察组术后完全清醒、能遵医嘱咳嗽、肢体可有意识活动的患者比率均显著高于对照组(P0.05);观察组术后1 h无痛的比率为56.41%,术后6 h无痛的比率为46.15%,术后24 h无痛的比率为38.46%,均显著高于对照组(P均0.05)。结论小剂量芬太尼复合氯胺酮、丙泊酚具有良好的麻醉、镇痛效果,对患儿的循环系统影响小,术后苏醒时间短,镇痛效果好,不良反应少,是小儿静脉全身麻醉较为理想的麻醉方法。

Effect of small dose of fentanyl combined with ketamine -propofol in intravenous anesthesia in children

Objective To observe the effect of small dose of fentanyl combined with ketamine- propofol in intravenous anesthesia,and to provide the reference for the clinical anesthesia scheme selection. Methods 78 patients were selected into this study. They were randomly divided into observation group and control group with 39 cases in each. The control group using ketamine combined with propofol anesthesia. The observation group was treated with small dose of fentanyl and ketamine propofol anesthesia. The two groups of patients during anesthesia heart rate（ HR）,respiratory rate（ RR）,oxygen saturation（ Sp O2） and recovery after operation,and uses the 11 point numeric rating scale were assessed after 24 h of pain. Results The RR,HR at 5 min after anesthesia,10 min after anesthesia of two groups children were significantly higher than before anesthesia（ P〈0. 05）. The comparison of Sp O2 before and after anesthesia,the differences were not statistically significant（ P〈0. 05）. The patients in the observation group is fully awake. These patients can follow the doctor＇s advice to cough,limb can be conscious activity. The ratio of these patients was significantly higher than that of control group（ P〉0. 05）. The proportion of 1 h painless patients in the observation group was56. 41%. The ratio of 6 h painless postoperative was 46. 15%. The ratio of 24 h painless postoperative was 38. 46%,which is significantly higher than that of control group（ all P〈0. 05）. Conclusion Small dose of fentanyl ketamine,propofol anesthesia has good analgesic effect. Circulation system on children＇s influence is small,postoperative recovery time is short,good analgesic effect,less adverse reaction,pediatric intravenous anesthesia is a ideal method.