腰麻与硬膜外联合加氯胺酮麻醉在小儿手术中的应用

目的观察腰麻-硬膜外联合加氯胺酮麻醉在小儿下腹及下肢手术中的麻醉效果及其并发症。方法将50例1—5岁患儿完全随机分为A、B两组，每组25例，A组行腰麻-硬膜外联合加氯胺酮麻醉，B组行氯胺酮静脉复合麻醉，观察比较2组术中氯胺酮用量，镇痛及肌松效果，麻醉苏醒时间及并发症。结果手术开始后0、5、10min，B组的心率、平均动脉压与A组相比明显增加（P〈0．01）。而呼吸的抑制程度则A组低于B组。手术开始后5min表现最为明显。手术开始后15min则2组各参数接近基础麻醉后水平。镇痛效果：A组25例均为I级；B组16例为I级，9例为II级；肌肉松弛效果：A组25例均为优，B组11例为优，8例为良，6例为差。2组镇痛及肌肉松弛效果比较，差异有统计学意义（P〈0．01）。A组氯胺酮总量明显少于B组。A组无头痛及脊神经损害等症状，B组中有5例发生喉痉挛；苏醒期A组2例躁动，1例出现精神症状，1例呕吐。B组7例躁动，4例出现精神症状，3例呕吐。结论腰麻-硬膜外联合加氯胺酮麻醉应用于小儿下腹及下肢手术具有麻醉效果确切、全身麻醉药用量较少、术后苏醒快、不良反应较少等优点。

The clinical application of spinal-epidural anesthesia combined with ketemine anesthesia in pediatric surgery

Objective To observe the effects of spinal-epidural anesthesia combined with ketemine anesthesia in pediatric surgery.Methods Fifty patients(ASA Ⅰ～Ⅱ)aged 1～5 years undergoing operation of abdomen or lower limbs were randomly divided into two groups:the Spinal-epidural anesthesia combined with ketamine anesthesia group(group A,n=25),ketamine intravenous anesthesia group(group B,n=25).Results The effect of anesthesia in group A was better than group B during the operation(P<0.05).The incidence of body movement and hrynx spasm was higher in group B(P<0.05).The quantity of ketamine was less in group A than that in group B.The recovery Was faster and more steadily in group A(P<0.05).Conclusions The Spinal-epidural Anesthesia combined with ketamine anesthesia used in operation of children can decrease the quantity of ketamine and reduce the uncomfortable response.Children's breath and circulation ale steady during the anesthesia and operation.