丙泊酚、瑞芬太尼復(fù)合氯胺酮用于小兒短小手術(shù)患兒的麻醉效果

張洪凱 張?jiān)孪?/p>

摘要：目的 ?探討丙泊酚、瑞芬太尼復(fù)合氯胺酮麻醉在小兒短小手術(shù)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(shù)的68例患兒臨床資料，根據(jù)麻醉用藥不同將34例采用氯胺酮麻醉的患兒設(shè)為對(duì)照組，將另外34例采用復(fù)合丙泊酚、瑞芬太尼麻醉的患兒設(shè)為觀察組，比較兩組血流動(dòng)力學(xué)[包括麻醉前（T0）、誘導(dǎo)后（T1）、切皮時(shí)（T2）、切皮后5 min（T3）、術(shù)畢時(shí)（T4）心率（HR）、平均動(dòng)脈壓（MAP）]、蘇醒時(shí)間以及不良反應(yīng)發(fā)生情況。結(jié)果 ?兩組T0時(shí)點(diǎn)HR、MAP比較，差異無統(tǒng)計(jì)學(xué)意義（P>0.05）;兩組T1～T4時(shí)點(diǎn)HR、MAP比較，差異有統(tǒng)計(jì)學(xué)意義（P<0.05），此外，觀察組蘇醒時(shí)間為（11.48±2.67）min，短于對(duì)照組的（15.01±2.94）min，差異有統(tǒng)計(jì)學(xué)意義（P<0.05）;觀察組不良反應(yīng)發(fā)生率為5.88%，低于對(duì)照組的23.53%，差異有統(tǒng)計(jì)學(xué)意義（P<0.05）。結(jié)論 ?丙泊酚、瑞芬太尼復(fù)合氯胺酮麻醉應(yīng)用于小兒短小手術(shù)效果良好，可穩(wěn)定患兒血流動(dòng)力學(xué)，縮短蘇醒時(shí)間，降低不良反應(yīng)發(fā)生幾率。

關(guān)鍵詞：小兒短小手術(shù);丙泊酚;瑞芬太尼;氯胺酮;血流動(dòng)力學(xué)

中圖分類號(hào)：R614 ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? 文獻(xiàn)標(biāo)識(shí)碼：A ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? DOI：10.3969/j.issn.1006-1959.2020.17.047

文章編號(hào)：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(shù)具有肌松要求低、手術(shù)時(shí)間短、麻醉深度淺等特征，由于患兒機(jī)體功能發(fā)育不成熟，耐受性及配合性較差，因而對(duì)麻醉質(zhì)量要求較高，既要利于手術(shù)順利進(jìn)行，又要避免心血管及呼吸抑制[1，2]。傳統(tǒng)小兒短小手術(shù)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(fā)躁動(dòng)不安、譫妄等并發(fā)癥，單獨(dú)應(yīng)用效果欠佳。丙泊酚為烷基酸類短效靜脈麻醉藥，可穩(wěn)定心血管功能，維持內(nèi)環(huán)境穩(wěn)態(tài)。瑞芬太尼則具有可控性強(qiáng)、血漿清除率高、半衰期短等特點(diǎn)。本研究結(jié)合2017年9月～2020年1月于我院行短小手術(shù)的68例患兒臨床資料，探討丙泊酚、瑞芬太尼復(fù)合氯胺酮麻醉對(duì)小兒短小手術(shù)患兒血流動(dòng)力學(xué)及蘇醒時(shí)間的影響，為臨床合理選擇麻醉藥物提供參考，現(xiàn)報(bào)道如下。