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目的:通过对氯胺酮合并异丙酚应用于小儿骶管阻滞麻醉探讨其复合麻醉的优点、安全性及效果,并与单纯辅助氯安酮或异丙酚作比较。方法:选择下腹部、会阴部手术患儿300例,ASAⅠ～Ⅱ级,年龄1～8岁,在基础麻醉下行骶管阻滞,随机分为3组辅助用药(用微泵持续输注):Ⅰ组,氯胺酮25μg.kg-1.min-1;Ⅱ组,异丙酚120μg.kg-1.min-1;Ⅲ组,氯胺酮10μg.kg-1.min-1+异丙酚45μg.kg-1.min-1。结果:3组综合麻醉效果满意,均能满足手术要求;术中镇静评分Ⅰ组4.23±0.6,Ⅱ组3.95±0.5,Ⅲ组4.12±0.6,组间无明显差异(P>0.05);注药后2minHR、MAP、SpO2变化有明显差异;术后苏醒时间Ⅰ组明显长于Ⅱ、Ⅲ组(P<0.05);苏醒期恶心呕吐、精神症状、躁动不安等不良反应的发生率Ⅲ组明显少于Ⅰ、Ⅱ组(P<0.05)。结论:氯胺酮+异丙酚辅助小儿骶管阻滞麻醉效果可靠,安全性高,不良反应少于单纯应用氯胺酮或异丙酚辅助小儿骶管阻滞。
OBJECTIVE: To compare the advantages, safety and efficacy of ketamine combined with propofol in pediatric caudal block anesthesia with simple adjuvant chlordane ketone or propofol. Methods: A total of 300 children with ASA Ⅰ ~ Ⅱ, aged 1 to 8 years old undergoing operation of the lower abdomen and perineum were randomly divided into 3 groups (continuous infusion with micropump) GroupⅠ, ketamine 25μg.kg-1.min-1; GroupⅡ, Propofol 120μg.kg-1.min-1; GroupⅢ, Ketamine 10μg.kg-1.min-1 + Propofol 45μg.kg -1.min-1. Results: The satisfactory results of the three groups of anesthesia can meet the surgical requirements. The intraoperative sedation score was 4.23 ± 0.6 in group Ⅰ, 3.95 ± 0.5 in group Ⅱ, 4.12 ± 0.6 in group Ⅲ, there was no significant difference between groups (P> 0.05) There were significant differences in HRR, MAP and SpO2 between the two groups (P <0.05). The recovery time of groupⅠwas significantly longer than that of groupⅡandⅢ (p <0.05), and the incidence of adverse reactions such as nausea, vomiting, Ⅰ, Ⅱ group (P <0.05). Conclusion: Ketamine + propofol assisted pediatric caudal block anesthesia is reliable, safe, and adverse reactions are less than the simple use of ketamine or propofol-assisted pediatric sacral block.