连续骶管麻醉应用于小儿脐以下手术的临床观察

目的观察连续骶管麻醉在小儿脐以下手术中的应用效果。方法选择1个月到6岁拟行脐以下手术患儿60例,随机分为A、B两组,每组30例,A组为氯胺酮基础麻醉加氯胺酮静脉麻醉,B组为氯胺酮基础麻醉加连续骶管麻醉。观察氯胺酮基础麻醉后（T0）、手术切皮时（T1）及手术结束时（T2）三个时点患儿心率（HR）、收缩压（SBP）、舒张压（DBP）、脉搏血氧饱和度（SpO2）变化,手术期间体动、恶心呕吐发生率、氯胺酮总用量和术后患儿苏醒时间。结果A组HR、SBP、DBP在T1、T2与T0相比,均显著升高（P〈0.05）,B组SBP和DBP三个时点无明显变化,但在T1、T2较A组低（P〈0.05）,B组HR在T1、T2与T0及A组相应相应时点减慢（P〈0.05）。2组SpO2比较差异无显著性（P〉0.05）。B组氯胺酮总用量、恶心呕吐发生率及术后苏醒时间均较A组少（P〈0.01）。B组术中平静,体动显著少于A组（P〈0.01）。结论氯胺酮基础麻醉加连续骶管麻醉应用于小儿脐以下手术,麻醉效果确切,患儿平稳安静,副作用少,术毕苏醒迅速,可连续给药而不受时间限制。

Clinical research of applying continuous caudal anesthesia in pedo-operation below omphalos

Objective To evaluate the clinical effects of continuous caudal anesthesia in pedo-operation.Methods Sixty children（ASA Ⅰ or Ⅱ）aged 1-72 months underwent operation below anesthesia（ketamine im）and ketamine 1-2 mg/kg.Group B received basal anesthesia（ketamine im）and a continuous caudal block with ropivacaine 0.125%-0.25%.Heart rate（HR）,systolic blood pressure（SBP）,diastolic blood pressure（DBP）,pulse oxygen saturation（SpO2）at the time just after basal anesthesia（T0）,immediately after the beginning of the operation（T1）and at the end of the operation（T2） were recorded.Nausea and vomitting frequency,ketamine dosage and restlessness frequency were recorded also.Results In group A,compared with T0,HR,SBP and DBP in T1 and T2 increased significantly（P〈0.05）.In group B,HR,SBP and DBP in three time points had no marked change,but at time points T1 and T2,they had significant diference compared with those in group A（P〈0.05）.SpO2 in two groups at three time points had no marked change,nausea and vomitting frequency,ketamine dosage and restlessness frequency in group B were less than that in group A significantly（P〈0.01）.Conclusion The effects of continuous caudal block after basal anesthesia in pedo-operation below omphalos in BP,HR and SpO2 are stable,ketamine dosage is small,children wake up more sooner and nausea and vomitting frequency is lower.