臂丛神经阻滞复合中／长链丙泊酚用于婴幼儿上肢手术的临床观察

目的探讨臂丛神经阻滞复合中／长链丙泊酚用于婴幼儿上肢手术的安全性和可行性。方法50例行上肢手术婴幼儿随机分为臂丛神经阻滞组（A组）和氯胺酮组（B组）。两组均用中／长链丙泊酚诱导后，A组0．20％罗哌卡因腋路臂丛阻滞，B组按需追加氯胺酮，两组术中均微量泵注中／长链丙泊酚。记录围手术期患儿HR、MAP、PET-CO3、SpO2，丙泊酚用量及其术后恶心呕吐等。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，术后恶心呕吐等较B组少（P〈0．05）；A组中／长链丙泊酚用量明显少于B组（P〈0．01）；与B组比，术后A组苏醒较快且平稳，恢复期精神症状较少（P〈0．05）。结论罗哌卡因臂丛神经阻滞复合中／长链丙泊酚麻醉应用于婴幼儿上肢手术，镇痛完全，可减少不良反应及丙泊酚用量，使婴幼儿在手术期间呼吸循环更平稳，且术后苏醒快。

Clinical efficacy of brachial block combined with middle/long chain propofol for the infant upper limb operations

Objective To evaluate the anesthetic effect and safety of brachial chain propofol in the infant patients undergoing the upper limb operations. Methods block combined with middle/long Fifty infants undergoing the upper limb operations were randomly divided into two groups, including group A （brachial block combined with middle/long chain propofol） and group B （middle/long chain propofol combined with ketamine）. After anesthesia was induced with certain doses of propofol, in group A successful brachial block was accomplished with 0. 2% ropivacaine following micropump infusion of propofol, whereas in group B propofol was continuously micro-pump infused following ketamine if necessary. The heart rate （HR）, mean arterial blood pressure （MAP）, PETCO2 and pulse oxygen saturation （SpO2） were measured during intraoperative anesthesia. The post-operative awake time, the total dose of propofol and the rate of post-operative nausea and vomiting were also recorded. Results Compared with group B, circulation and respiratory function during surgery in group A is more stable （P〈0.05）. Limbs＇ dys-automatie action and the rates of postoperative nausea and vomiting in group A decreased more significantly than those in group B （P〈0. 05）. Compared with group B postoperative palinesthesia in group A was quicker and more stable and psychiatric symptom during recovery stage was inhibited more notably. The total dose of propofol in group A was less than in group B. （P〈0. 05）. Conclusion In the infant patients undergoing the upper limb operations, brachial block combined with middle/long chain propofol is superior to middle/long chain propofol combined with ketamine in maintaining hemodynamic stability and reducing the total dose of propofol and the incidences of postoperative nausea and vomiting.