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目的探讨罗哌卡因骶管阻滞辅以氯胺酮用于小儿经肛门先天性巨结肠I期根治术的麻醉效果及对患儿应激反应的影响。方法48例先天性巨结肠根治术随机分为两组,A组:罗哌卡因骶管阻滞辅以氯胺酮;B组:用羟丁酸钠慢诱导气管插管辅以氯胺酮和维库溴胺。观察麻醉效果,连续监测HR、RR、SpO_2、ECG、有创血压,并分别于基础麻醉后(T_0)、手术开始5分钟(T_1)、1小时(T_2)、2小时(T_3)、术毕(T_4)抽取左侧挠动脉血测定血气、血糖和血浆皮质醇含量。结果A、B两组循环、呼吸均平稳,A组血糖各时点与基础值T_0无明显差异,而明显低于B组各时点(P<0.05),A组皮质醇T_2 T_3高于T_0、T_1和T_4(P<0.05),而明显低于B组各时点(P<0.05)。结论 罗哌卡因骶管阻滞辅以氯胺酮用于经肛门先天性巨结肠I期根治术是比较适宜的麻醉方法,并能较好抑制患儿应激反应。
Objective To investigate the anesthetic effects of ropivacaine caudal block combined with ketamine for the treatment of pediatric transanal Hirschsprung’s disease and its effect on stress response in children. Methods 48 cases of Hirschsprung’s disease were randomly divided into two groups, Group A: ropivacaine caudal block combined with ketamine; Group B: sodium oxybate slowly induced by tracheal intubation supplemented with ketamine and VK amine. The anesthesia effects were observed and HR, RR, SpO2, ECG and IBP were monitored continuously. After the start of basic anesthesia (T_0), 5 minutes (T_1), 1 hour (T_2) and 2 hours (T_4) to extract left ventricular artery blood gas, blood glucose and plasma cortisol levels. Results The circulation and respiration of group A and group B were stable. There was no significant difference between group A and group B at each time point, but significantly lower than group B at each time point (P <0.05). The level of C 2 T 3 in group A was higher than that at T 0 , T_1 and T_4 (P <0.05), but significantly lower than those in group B (P <0.05). Conclusions Ropivacaine caudal block combined with ketamine for ananectal Hirschsprung radical hysterectomy is more appropriate anesthesia, and can better inhibit the stress response in children.