摘要
目的研究小剂量右美托咪定辅助氯胺酮麻醉在小儿先心病封堵术中应用的可行性。方法选择拟行介入封堵术的患儿60例,随机均分为氯胺酮组（K组）和氯胺酮＋右美托咪定组（KD组）。两组均采用不插管全麻,保留自主呼吸的方式进行;两组均先用氯胺酮1mg/kg诱导,然后以10~30μg/（kg·min）速率维持;KD组则复合右美托咪定给药,先按0.2~0.5μg/kg给予一个负荷剂量,然后再以0.05~0.1μg/（kg·h）进行持续泵注。观察并记录两组患儿诱导后、手术开始后3min、5min、10min、20min各时点的HR、MAP、SpO_2数值;同时记录两组患儿氯胺酮的总用量（T1）、体动发生率（T2）、呼吸抑制发生率（T3）、苏醒期躁动发生率（T4）、谵妄的发生率（T5）和手术时间（T6）。结果两组患儿年龄、性别、体重、手术种类、ASA分级、NYHA分级方面等差异均无统计学意义（P〉0.05）,与K相比,KD组手术开始后的心率、血压明显下降,差异有统计学意义（P〈0.05）;组内比较无明显的变化,差异无统计学意义（P〉0.05）;KD组的体动发生率明显低于K组（P〈0.05）,但对呼吸的抑制却不明显,在面罩吸氧状态下均能保持SPO_2在95%~100%之间;与K组相比,KD组患儿苏醒期躁动和谵妄的发生率都明显降低,差异有统计学意义（P〈0.05）。另外,在手术时间无明显差别的情况下,KD组氯胺酮的总用量则明显减少,差异有统计学意义（P〈0.05）。结论应用小剂量右美托咪定辅助氯胺酮麻醉在小儿先心病封堵术中是安全可行的。
Objective Feasibility study of low-dose dexmedetomidine aid given ketamine anesthesia in children with congenital heart disease occlusion Application. Methods Select undergoing interventional therapy in children 60 cases were randomly divided into ketamine group（ K group） and ketamine ＋ dexmedetomidine given group（ KD group）. Both groups were not intubation,spontaneous respiration were reserved manner; both groups first with ketamine 1mg / kg induction,then maintained to 10 ~30μg /（ kg·min） rate; KD Group is a composite dextromethorphan detomidine administration,press 0. 2 ~ 0. 5μg / kg administered a loading dose,then to 0. 05 ~ 0. 1μg /（ kg·h） for continuous infusion. Observed and recorded two children after induction,after surgery began 3min,5min,10 min,20min HR,MAP,Sp O2 values at each time point; and record the total amount of the two groups of children with ketamine（ T1）,the incidence of body motion（ T2）,the incidence of respiratory depression（ T3）,restlessness incidence（ T4）,the incidence of delirium（ T5） and surgical time（ T6）. Results the differences of Two groups of children of age,sex,weight,type of surgery,ASA classification,NYHA classification and other aspects were no statistically significant difference compared with the K,KD operative after the start of heart rate,blood pressure decreased significantly（ P〈0. 05）; There were no significant changes（ P〈0. 05）; body moving KD group was significantly lower than K group（ P〈0. 05）,but not significant inhibition of respiration,oxygen masks in the state able to maintain Sp O2 in between 95% to 100%; compared with the K group,the group of children with KD restlessness and incidence of delirium were significantly lower（ P〈0. 05）. In addition,no significant difference in operative time under the circumstances,the total amount of KD group ketamine significantly reduced（ P〈0. 05）. Conclusion Low-dose dexmedetomidine aid given ketamine anesthesia in children with congenital heart block surgery is safe and feasible.
出处
《四川医学》
CAS
2015年第12期1691-1694,共4页
Sichuan Medical Journal
关键词
小剂量
右美托咪定
氯胺酮
先心病
封堵术
low dose
dexmedetomidine
ketamine
congenital heart disease
occlusion
