低齡小兒簡骶麻兩種靜脈輔助方法的臨床療效比較

摘 要 目的:通過對兩種靜脈淺全麻輔助方法療效的比較，以往推薦較優越的一種。方法:選擇即將進行腹股溝或會陰區手術的低齡小兒(2～6歲)60例，并隨機分成簡骶麻加異丙酚芬太尼組(PFS組，n=30)和簡骶麻加咪唑安定氯胺酮麻醉組(DKS組，n=30)。前組于小兒入室后即行簡骶麻醉，完成操作后再注射芬太尼和丙泊酚靜脈誘導，持續微泵丙泊酚維持;后組則簡骶麻后，用氯胺酮和咪唑安定誘導，靜脈泵注氯胺酮維持。觀察記錄麻醉前后平均動脈壓(MAP)、心率(HR)、呼吸頻率(R)、脈搏氧飽和度(SPO.2)的變化程度以及術后蘇醒時間，術中術后躁動、嘔吐等不良反應的發生率。結果:兩組小兒的一般情況、麻醉前生命體征及手術時間差異均無顯著性，麻醉后1、5、10、15分鐘分別與麻醉前相比，PFS組和DKS組的MAP、SPO.2均差異無顯著性，而HR及R均呈顯著性變化(P<0.01或P<0.05)。PFS組術后清醒時間較短，術中及術后躁動、嘔吐等不良反應發生很少(P<0.01)。

關鍵詞 低齡小兒 兩種輔助麻 療效 比較

doi:10.3969/j.issn.1007-614x.2010.22.133

AbstractObjective:To recommend a better treatment by comparing 2 Intravenous Use of Mild General Anesthetics.Method:60 young (2～6) patients intending for inguinal or perineum operation were selected and divived into caudal anesthesia propofol and fentanyl added group (PFS group， n=30) and caudal anesthesia midazolam ketaminge group (DKS group， n=30). The former group of children were pilo anesthetized and injected with fentanyl and propofol intravenous induction，with fentanyl in micropump maintained continuously; the latter group were induced via midazolam and ketamine after caudal anesthesia， with ketamine maintained continuously. Change degree and postoperative recovery time of preoperative and postoperative Average arterial pressure (MAP)， heart rate (HR)， respiratory rate (R)， pulse oximetry (SPO.2) as well as incidence of reverse reaction including intraoperative and postoperative restlessnes， vomiting were observed and recorded. Compared with that before anesthesia， both MAP and SPO.2 in PFS group and DKS group were not remarkably different 1， 5， 10， 15 min. after anesthesia with remarkable differences in HR and R (P<0.01 or P<0.05). PFS group had a shorter postoperative recovery time with low incidence of reverse effects such as intraoperative and postoperative restlessnes， vomiting (P<0.01).

Key WordsYoung Children;2 Assisted Anesthesia;Curative Effect;Comparison

簡單骶麻具有操作簡單，對呼吸循環影響小等優點，被廣泛應用于低位區域手術的麻醉。但由于小兒不合作的心理和生理等因素，除了局部麻醉以外，還必須輔以淺全麻。

我科自2006年起至今，共施行小兒骶麻100余例，其中的低齡小兒(2～6歲)均采用了氯胺酮復合咪唑安定或丙泊酚復合芬太尼靜脈強化輔助。

現隨機各抽取30例進行麻醉療效比較，發現丙泊酚復合芬太尼輔助組效果更為理想。詳細報告如下。