丙泊酚、瑞芬太尼復合氯胺酮用于小兒短小手術患兒的麻醉效果

張洪凱 張月霄

摘要：目的 ?探討丙泊酚、瑞芬太尼復合氯胺酮麻醉在小兒短小手術患兒中的麻醉效果。方法 ?回顧性分析2017年9月～2020年1月我院行短小手術的68例患兒臨床資料，根據麻醉用藥不同將34例采用氯胺酮麻醉的患兒設為對照組，將另外34例采用復合丙泊酚、瑞芬太尼麻醉的患兒設為觀察組，比較兩組血流動力學[包括麻醉前（T0）、誘導后（T1）、切皮時（T2）、切皮后5 min（T3）、術畢時（T4）心率（HR）、平均動脈壓（MAP）]、蘇醒時間以及不良反應發生情況。結果 ?兩組T0時點HR、MAP比較，差異無統計學意義（P>0.05）;兩組T1～T4時點HR、MAP比較，差異有統計學意義（P<0.05），此外，觀察組蘇醒時間為（11.48±2.67）min，短于對照組的（15.01±2.94）min，差異有統計學意義（P<0.05）;觀察組不良反應發生率為5.88%，低于對照組的23.53%，差異有統計學意義（P<0.05）。結論 ?丙泊酚、瑞芬太尼復合氯胺酮麻醉應用于小兒短小手術效果良好，可穩定患兒血流動力學，縮短蘇醒時間，降低不良反應發生幾率。

關鍵詞：小兒短小手術;丙泊酚;瑞芬太尼;氯胺酮;血流動力學

中圖分類號：R614 ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? 文獻標識碼：A ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? DOI：10.3969/j.issn.1006-1959.2020.17.047

文章編號：1006-1959（2020）17-0157-03

Abstract：Objective ?To investigate the anesthesia effect of propofol and remifentanil combined with ketamine anesthesia in children with short surgery.Methods ?A retrospective analysis of the clinical data of 68 children who underwent short surgery in our hospital from September 2017 to January 2020. According to the different anesthesia medications， 34 children who underwent ketamine anesthesia were set as the control group， and the other 34 cases were combined the children anesthetized with propofol and remifentanil were set as the observation group， and the hemodynamics of the two groups were compared [including before anesthesia （T0）， after induction （T1）， during skin incision （T2）， and 5 min after skin incision （T3）， heart rate （HR）， mean arterial pressure （MAP） at the end of the operation （T4）]， recovery time， and occurrence of adverse reactions.Results ?There was no statistically significant difference in HR and MAP between the two groups at T0 （P>0.05）; the difference in HR and MAP between the two groups at T1～T4 was statistically significant （P<0.05）. In addition， the time to wake up in the observation group was （11.48±2.67） min， which was shorter than （15.01±2.94） min in the control group，the difference was statistically significant （P<0.05）; the adverse reaction rate in the observation group was 5.88%， which was lower than 23.53% in the control group，the difference was statistically significant（P<0.05）.Conclusion ?Propofol， remifentanil combined with ketamine anesthesia had a good effect in pediatric short surgery， which could stabilize the hemodynamics of the child， shorten the recovery time， and reduce the incidence of adverse reactions.

Key words：Pediatric short surgery;Propofol;Remifentanil;Ketamine;Hemodynamics

小兒短小手術具有肌松要求低、手術時間短、麻醉深度淺等特征，由于患兒機體功能發育不成熟，耐受性及配合性較差，因而對麻醉質量要求較高，既要利于手術順利進行，又要避免心血管及呼吸抑制[1，2]。傳統小兒短小手術麻醉用藥主要以氯胺酮為主，但由于其可造成心血管過度興奮，引發躁動不安、譫妄等并發癥，單獨應用效果欠佳。丙泊酚為烷基酸類短效靜脈麻醉藥，可穩定心血管功能，維持內環境穩態。瑞芬太尼則具有可控性強、血漿清除率高、半衰期短等特點。本研究結合2017年9月～2020年1月于我院行短小手術的68例患兒臨床資料，探討丙泊酚、瑞芬太尼復合氯胺酮麻醉對小兒短小手術患兒血流動力學及蘇醒時間的影響，為臨床合理選擇麻醉藥物提供參考，現報道如下。