七氟醚复合不同静脉麻醉药对小儿术后呕吐的影响

目的：探讨七氟醚复合不同剂量的氯胺酮,辅助丙泊酚、咪达唑仑、氟哌利多静脉麻醉对小儿全麻（气管插管组和非插管组）术后呕吐（POV）的影响及安全性。方法：选择1～7岁,8kg以上,无先天性心肺疾病、近期无严重上呼吸道感染、ASAⅠ～Ⅱ级,择期手术的患儿96例。随机分为持续吸入七氟醚复合静脉注射氯胺酮、异丙酚、咪达唑仑、氟哌利多组（组1）;间断吸入吸入七氟醚复合肌注氯胺酮组（组2）;间断吸入七氟醚复合肌注氯胺酮辅以咪达唑仑组（组3）,每组32例。各组患儿切皮前均常规静注地塞米松。麻醉过程中监测呼吸循环相关参数,记录麻醉效果;术毕全醒后（有气管插管的拔除导管）在麻醉恢复室（PACU）观察30min,各生命体征平稳、警觉镇静（改良OAA/S）评分4分以上,送返病房继续观察有无呕吐及呼吸、心率参数等。皆行PCIA术后镇痛。结果：组1呕吐发生率明显低于2、3组（P〈0.05）,组2、3间差异无统计学意义（P〉0.05）。结论：持续七氟醚复合静脉注射氯胺酮,辅以异丙酚、咪达唑仑、氟哌利多麻醉用于幼儿全麻,术后呕吐发生率明显降低。

Sevoflurane combined with different intravenous anesthetics on postoperative vomiting in children

Objective： To discuss the influence and safety of combination usage of sevoflurane with different doses of Ketamine, Assisted Propofol, Midazolam, Droperidol anesthesia intravenous anesthesia in children （endotraeheal intubation group and the non-intubation group） for Postoperative Vomiting （POV）. Methods： Chose 96 children aged from 1 to 7 years, weight 8 kg above, with no congenital heart and lung disease, recently no serious upper respiratory tract infection, ASA I - II grade. Randomly assigned samples into 3 groups, 1 group was constantly inhaled with Sevoflurane and was injected with Ketamine, Propofol, Midazolam, Droperidol; 2 group was intermittently inhaled with Sevoflurane and was injected of Ketamine; 3 group was intermittent inhaled of Sevoflurane, injected with Ketamine and was supplemented with Midazolam. Each group of 32 eases. Before skin incision, were eondueted a routine intravenous injection of Dexamethasone. During anesthesia, monitor parameters about respiration circle and record anesthesia results; Observed all samples after surgery （removal of a tracheal intubation catheter） in the anesthesia recovery room （PACU） for 30 minutes. With stable vital signs and an above 4 score in alertness sedation （Modified OAA/S）, samples were returned t3 the ward and we further observed whether they had vomiting, respiratory and heart rate parameters. All groups were treated with PCIA postoper ative analgesia. Results： One group＇s rate of vomiting was significantly lower than 2 group and 3 （P〈0.05）, 2 group and 3 group had no significant difference （P〉0.05）. Conclusion： Constant treatment with combination of Sevoflurane and intravenous injection of Ketamine, supplemented with Propofol, Midazolam, Droperidol, deereases rate of postoperative vomiting in chil- dren＇s general anesthesia.