摘要
目的:观察采用七氟烷喉罩吸入和氯胺酮静脉注射麻醉方法的非住院眼科患儿术后恢复情况和不良反应,比较2种药物的麻醉效果和安全性。方法:选择2008年1月至2008年12月在首都医科大学附属北京同仁医院眼科接受白内障、青光眼、斜视、眼整形、视网膜和角膜等手术的2773例患儿,年龄4个月～14岁。分为七氟烷喉罩麻醉组(七氟烷组,1074例)和氯胺酮静脉麻醉组(氯胺酮组,1699例)。七氟烷组男698例,女376例,平均年龄(4.0±3.0)岁。氯胺酮组男1056例,女643例,平均年龄(5.4±3.0)岁。七氟烷组患儿面罩下吸入七氟烷,其浓度从5%逐渐增至8%,氧流量为5L/min。待患儿意识消失后开放静脉并置入喉罩,术中用1.5%～2.5%七氟烷维持麻醉。氯胺酮组患儿开放静脉后给予氯胺酮2mg/kg,溶于0.9%氯化钠注射液10mL静脉推注,术中用0.5～1.0mg/kg氯胺酮间断静脉推注维持麻醉。记录并分析2组患儿Aldrete评分、麻醉后恢复室(PACU)停留时间及围手术期的不良反应。结果:2组患儿离开PACU时Aldrete评分均为10分;患儿在PACU停留时间七氟烷组为(23.6±16.1)min,氯胺酮组为(56.2±34.9)min,差异有统计学意义(P<0.01)。七氟烷组内行不同术式患儿PACU停留时间差异均无统计学意义(P>0.05);氯胺酮组行白内障超声乳化和(或)人工晶体植入术与眼整形术患儿的PACU停留时间较行斜视矫正术患儿短,差异有统计学意义(P<0.05)。七氟烷组的患儿有90%在麻醉诱导期出现一过性心动过速,但均在10s内恢复正常。氯胺酮组有6例患儿术中脉搏血氧饱和度<92%。患儿术后兴奋躁动的发生率七氟烷组为47.6%(511例),氯胺酮组为39.8%(676例);患儿术后恶心呕吐的发生率例七氟烷组为8.4%(90例),氯胺酮组为10.2%(173例),差异均无统计学意义(均P>0.05)。结论:七氟烷喉罩吸入较氯胺酮静脉注射的麻醉效果好,术后恢复快,不良反应少,适用于小儿眼科非住院手术。
Objective：To observe postoperative recovery and adverse reactions after application of sevoflurane inhalation anesthesia with laryngeal mask and ketamine intravenous anesthesia in ambulatory children undergoing eye surgery in order to compare the anesthetic effectiveness and safety of the two different types of anesthetic agents. Methods：Two thousand seven hundred and seventy-three children aged from 4 months to 14 years undergoing cataract,glaucoma,strabismus,ophthalmoplasty,retina,or corneal surgeries at Beijing Tongren Hospital from January to December 2008 were divided into the following two groups：the sevoflurane inhalation anesthesia with laryngeal mask group （the sevoflurane group,n=1 074） and the ketamine intravenous anesthesia group（the ketamine group,n=1 699）. The sevoflurane group comprised 698 boys and 376 girls with average age of （4.0±3.0） years. The ketamine group comprised 1 056 boys and 643 girls with average age of （5.4±3.0）years. The children in sevoflurane group received sevoflurane inhalation by mask,and its concentration was increased from 5% to 8% with an oxygen flow rate of 5 L/min. After the patients lost consciousness,venipuncture was established and then the laryngeal mask was inserted,and sevoflurane 1.5%-2.5% was given for maintenance anesthesia during the surgery. The children in the ketamine group received ketamine 2 mg/kg in 10 mL of 0.9% sodium chloride injection intravenously after venipuncture was established,and ketamine 0.5-1.0 mg/kg was given intermittently for maintenance anesthesia during the surgery. Aldrete Scores,PACU length of stay,and adverse reactions during intraoperation period were recorded and analyzed. Results：The children having a score of 10 were discharged from PACU. The length of PACU stay of patients was （23.6±16.1） min and （56.2±34.9） min in the sevoflurane and ketamine groups,respectively. The difference was statistically significant （P〈0.01）. There was no significant difference in length of PACU stay of patients undergoing different types of surgeries in the sevoflurane group （P〈0.05）. While the length of PACU stay of patients undergoing phacoemulsitication,intraocular lens implantation,and ophthalmoplasty was shorter than that of patients undergoing strabismus surgery. The difference was statistically significant （P〈0.05）. Ninety percent of patients in the sevoflurane group developed tachycardia which normalized within 10 seconds during induction of anesthesia. Six patients＇SpO2 in the ketamine group was less than 92% during surgery. The incidence of postoperative agitation was 47.6% （511 cases） and 39.8% （676 cases） in the sevoflurane and ketamine groups,respectively. The incidence of nausea and vomiting was 8.4% （90 cases） and 10.2% （173 cases） in the sevoflurane and ketamine groups,respectively. The difference was not statistically significant （P〈0.05）. Conclusion：Sevoflurane inhalation anesthesia with laryngeal mask has higher anesthetic effectiveness,more rapid recovery after surgery,and has less adverse reactions compared with ketamine intravenous anesthesia; and it is suitable for non-hospitalized children undergoing eye surgery.
出处
《药物不良反应杂志》
2010年第4期229-233,共5页
Adverse Drug Reactions Journal
基金
首都医学发展科研基金资助项目(2007-1037)
关键词
全身麻醉
小儿
眼科
七氟烷
氯胺酮
恢复时间
不良反应
general anesthesia
pediatric
ophthalmology
sevoflurane
ketamine
recovery time
adverse reactions
