氯胺酮联合丙泊酚在小儿无痛肠镜检查中的应用

目的观察氯胺酮复合丙泊酚静脉麻醉在小儿无痛全结肠镜中的麻醉效果。方法将行无痛全结肠镜检查患儿200例完全随机分为观察组和对照组，各100例。观察组：静脉注射氯胺酮1mg／kg后，再缓慢静脉注射丙泊酚1～3mg／kg（从1mg／kg开始逐步递增直至睫毛反射消失）。对照组：静脉注射丙泊酚1～3mg／kg。待患儿安静入睡，睫毛反射消失后开始进镜，术中根据不引起体动反应，方便术者操作，维持恰当的麻醉深度和正常的生命体征来适时追加丙泊酚。监测2组患儿麻醉前（T0）、麻醉后进镜前（T1）、进镜时（T2）、检查结束时（T3）及苏醒时（T4）时的平均动脉压（MAP）、HR、脉搏血氧饱和度（SpO2）和呼吸的变化；记录麻醉诱导时间、手术时间、苏醒时间、丙泊酚的用量、阿托品和麻黄碱使用情况。记录术中体动反应、低氧血症、心动过缓、低血压、肌阵挛及术后有关并发症的发生情况。结果观察组T0、T1、T2、T3及T4时的MAP分别为（68±9）、（64±8）、（60±8）、（62±8）、（64±9）mmHg（1mmHg=0．133kPa），对照组T0、T1、T2、T3及T4时的MAP分别为（65±8）、（57±6）、（55±6）、（56±6）、（59±8）MInHg；观察组T0、T1、T2、T3及T4时的HR分别为（92±8）、（89±7）、（85±8）、（86±8）、（86±9）次/min，对照组T0、T1、T2、T3及T4时的HR分别为（89±6）、（86±6）、（81±6）、（84±6）、（87±7）次/min；2组患儿麻醉后各时间点MAP、HR比麻醉前均降低，组间差异有统计学意义（P〈0．05）；对照组T2时MAP降低更明显，与观察组同时间点比较差异有统计学意义（P〈0．05）。2组患儿麻醉后各时间点SpO，无变化，组间差异无统计学意义（P〉0．05）。观察组T0、T1、T2时呼吸频率分别为（23．1±4．2）、（20．7±4．1）、（18．5±2．4）次／min，对照组T0、T1、T2时呼吸频率分别为（22．2±3．8）、（20．4±3．8）、（17．5±4．1）次／min，2组患儿T1、T2时的呼吸频率与麻醉前比较差异均有统计学意义（P〈0．05）；对照组T1、T2时呼吸频率与观察组同时间点比较差异均有统计学意义（均P〈0．05）。与对照组比较，观察组低血压发生率降低，组间差异有统计学意义52．0％（52／100）比67．O％（67／100），P〈0．05]。结论氯胺酮复合丙泊酚用于小儿无痛肠镜检查对呼吸和循环影响轻，术中及术后并发痒发牛率低。

Clinical application of ketamine combined with propofol in children painless colonoscopy

Objective To obeserve the efficacy of ketamine combined with propofol for children painless colonoseopy. Methods Totally 200 children undergoing painless eolonoscopy were randomly allocated into observation group and control group. Observation group was given ketamine 1 mg/kg and then propofol 1-3 mg/kg until disappearance of eyelash reflex. Control group was given propofol 1-3 mg/kg, colonoscopy was performed until disappearance of eyelash reflex. Additional propofol was given according to the response to surgical stimuli, depth of anesthesia and convenience of the operaters. Mean arterial pressure （MAP）, pulse oxygen saturation（ SpO2 ）, heart rate（HR） and respiration rate （RR） were continously monitored and recorded before anesthesia （To ）, before colonoscopy intubation（TI ）, during Colonoscopy intubation（T2 ）, at the end of operation（T3 ）and the time of wake up（T4）. The anesthesia induction time, colonoscopy time, the amount of propofol administered, the number of cases who used atropine and ephedrine, the anesthetic efficacy assessed by anesthetist and endoscopist and recovery time were recorded. In addition intraoperative body movement, apnea, hypoxemia, bradycardia, hypotension, myoclonus, injection pain and postoperative complications were also recorded. Results In observation group, MAP was （68 ± 9 ）mm Hg, （64 ± 8 ）mm Hg, （60 ± 8 ）mm Hg, （62 ± 8 ） mm Hg, （64 ± 9 ）mm Hg respectively in T0, T1, T2, T3 and T4. In control group, MAP was （65 ±8）mm Hg, （57±6）mm Hg, （55 ±6）mm Hg, （56 ±6）ram Hg and （59 ± 8）mm Hg respectively in T0, T1, T2, T3 and T4. In observation group, HR was （92 ± 8）times/rain, （89 ± 7） times/min, （85 ± 8 ） times/rain, （86± 8 ） times/min and （86 ± 9 ） times/min respectively in T0, T1, T2, T3 and T4. In control group, HR was （89 ± 6） times/rain, （86 ± 6） times/min, （81± 6） times/rain, （84 ±6）times/rain and （87 ±7）times/rain respectively in T0, T1 , T2, T3 and T4. Compared with To, MAP and HR of two groups in T1 were decreased （P 〈 0.05）. In two groups, SpO2 were not effected in TO to T4 （P 〉 0.05）. In observation group, RR were （23. 1 ±4. 2） times/rain, （20. 7± 4. 1 ） times/min, （ 18. 5 ± 2.4） times/min respectively in T0, T1, T2. In control group, RR was （22.2 ± 3.8） times/rain, （20.4 ± 3.8） times/min, （ 17.5± 4.1 ） times/rain respectively in T0, T1, T2. Compared with T0, RR of two groups was decreased significantly （ P 〈 0.05）. In control group, RR was decreased much more in T1 , T2. Compared with control group, hypotension in observation group was significantly reduced 52.0% （52/100） vs 67.0% （67/100）, P 〈 0.05 ]. Conclusions Ketamine combined with propofol has little inhibitory effect on circulatory and respiratory function in children undergoing colonoscopy.