摘要
目的比较氯胺酮单独应用或复合右美托咪定作为小儿术前用药的有效性与安全性。方法选择ASAⅠ～Ⅱ级择期行白内障手术的患儿60例,年龄3～6岁,体重10～20kg,随机分为氯胺酮组(K6组,氯胺酮6mg/kg口服)和氯胺酮复合右美托咪定组(K3D2组,氯胺酮3mg/kg口服+右美托咪定2μg/kg滴鼻),每组30例。患儿术前30min在麻醉等待室接受用药,记录药物接受情况、滴鼻前(T0)及用药后10、20、30min时(T10、T20、T30)的心率(HR)、脉搏氧饱和度(SpO2)和患儿入睡时间,根据镇静评分表(sedation scale,SS)评估用药后10、20、30min时的镇静状态,用药30min后根据情绪状态评分表(emotional state scores,ESS)评估患儿与父母分离转入手术室的情绪状态以及对外周静脉穿刺置管的反应,同时还记录患儿拔管时间、苏醒时间及术后24h随访情况。结果 K3D2组患儿入睡时间短,T20、T30时镇静状态明显优于K6组(P<0.05);且与父母分离时情绪状态及静脉穿刺评分明显低于K6组(P<0.05)。K6组患儿术后恶心、呕吐及精神异常情况明显多于K3D2组(P<0.05)。结论氯胺酮3mg/kg口服复合右美托咪定2μg/kg滴鼻可以使患儿安静地与父母分离并接受外周静脉穿刺,是理想的小儿术前用药选择。
Objective To compare the effect and dexmedetomidine for premedication in children. Methods security of ketamine with or without Sixty pediatric patients,aging 2 to 6 years, weighing 10 to 20 kg, ASA Ⅰ to Ⅱ , underwent cataract operation were randomly divided into 2 groups, with 30 cases each. K6 group received ketamine 6 mg/kg p. o and normal saline solution 0.2 mL/kg intranasal 30 min before surgery;K3D2 group received ketamine 3 mg/kg p. o plus dexmedetomidine 2μg/kg intranasal 30 min before surgery. We recorded HR and SpO2 before premedication （T0） and 10,20,30 rain after administration （T10 ,T20, T30 ） and the time in need for sedation. Sedation scale （SS） was used to assess patientsr sedation state at the time points of T10 ,T20 and T30. Emotional state scores （ESS） was used to assess patientsI emotional state when they were separated from their parents and their reaction during venepuncture. Results Premedication were well tolerated in all children. The mean time in need for sedation was longer in K6 group than that in K3D2 group, the sedation level in K3D2 group at T20 and T30 were superior to that in K6 group. ESS at separation from parents and during venepuncture were lower in K3D2 group than in K6 group. Conclusions K3D2 group provides satisfactory sedation with less side-effects. The oral ketamine 3 mg/kg plus intranasal dexmedetomidine 2 μg/kg for premedication in children is the just choice.
出处
《复旦学报（医学版）》
CAS
CSCD
北大核心
2013年第3期363-366,共4页
Fudan University Journal of Medical Sciences
