CAJ | 학술논문

目的观察静脉麻醉药氯胺酮和异丙酚对小儿眼内压的影响。方法选择ASAⅠ～Ⅱ级患儿27例，分为氯胺酮组和异丙酚组。肌注氯胺酮4～6 mg*kg-1和氟哌利多0.04～0.1 mg*kg-1基础麻醉后，氯胺酮组单次静注氯胺酮1 mg*kg-1，继之静滴0.04%氯胺酮，必要时间断追加氯胺酮；异丙酚组单次静注异丙酚1 mg*kg-1，继之静滴0.04%异丙酚，必要时间断追加异丙酚和氯胺酮。分别于基础麻醉后10 min、单次静注氯胺酮和异丙酚3 min及手术结束后测眼内压，并监测收缩压（SBP）、舒张压（DBP）、心率（HR）和脉搏血氧饱和度（SpO2）。结果两组患儿基础麻醉后眼内压无差异，单次静注氯胺酮眼内压升高，单次静注异丙酚则眼内压下降（P<0.05）；手术结束后，氯胺酮组眼内压下降，与异丙酚组差异无统计学意义。基础麻醉后至手术结束，SBP、DBP、HR变化两组间差异无统计学意义。静注氯胺酮后5 min内，SpO2其中1例<95%，余无下降，静注异丙酚后5 min内，SpO2下降与基础麻醉后比差异有统计学意义，其中3例<95%。结论单纯静注氯胺酮可升高眼内压，静注异丙酚降低眼内压，两者复合应用可避免眼内压升高，但呼吸抑制作用增强。
목적관찰정맥마취약록알동화이병분대소인안내압적영향。방법선택ASAⅠ～Ⅱ급환인27례，분위록알동조화이병분조。기주록알동4～6 mg*kg-1화불고리다0.04～0.1 mg*kg-1기출마취후，록알동조단차정주록알동1 mg*kg-1，계지정적0.04%록알동，필요시간단추가록알동；이병분조단차정주이병분1 mg*kg-1，계지정적0.04%이병분，필요시간단추가이병분화록알동。분별우기출마취후10 min、단차정주록알동화이병분3 min급수술결속후측안내압，병감측수축압（SBP）、서장압（DBP）、심솔（HR）화맥박혈양포화도（SpO2）。결과량조환인기출마취후안내압무차이，단차정주록알동안내압승고，단차정주이병분칙안내압하강（P<0.05）；수술결속후，록알동조안내압하강，여이병분조차이무통계학의의。기출마취후지수술결속，SBP、DBP、HR변화량조간차이무통계학의의。정주록알동후5 min내，SpO2기중1례<95%，여무하강，정주이병분후5 min내，SpO2하강여기출마취후비차이유통계학의의，기중3례<95%。결론단순정주록알동가승고안내압，정주이병분강저안내압，량자복합응용가피면안내압승고，단호흡억제작용증강。
Objective　To observe the influence of intravenous anesthesia with ketamine or propofol on intraocular pressure (IOP) in pediatric patients. Methods　27 pediatric patients, ASA grade Ⅰ～Ⅱ, were divided into ketamine and propofol groups. Basic anesthesia was conducted with ketamine 4～6 mg*kg-1 combined droperidol 0.04～0.1 mg*kg-1 intramuscularly. Anesthesia maintained with continous infusion of 0.04% ketamine or 0.04% propofol following intravenous bolus of ketamine 1 mg*kg-1 or propofol 1 mg*kg-1 in ketamine group and propofol group respectively. IOP, systemic blood pressure(SBP), diastolic blood pressure(DBP), heart rate(HR) and pulse oxygen saturation(SpO2) were measured at 10 minutes after basic anesthesia, 3 minutes after intravenous bolus of ketamine or propofol and end of surgery. Results　There were no differences in IOP between two groups after basic anesthesia. IOP increased or decreased significantly after intravenous bolus of ketamine or propofol respectively. IOP in ketamine group decreased near to the level in propofol group at end of surgery. There were no statistic differences in SBP, DBP and HR between two groups priopration. SpO2 did not change (but in one patient decreasing to below 95% ) and significantly decreased within 5 minutes of intravenous bolus of ketamine and propofol respectively. Conclusion　Ketamine increases IOP propofol decreases IOP. Ketamine combined propofol can keep from increase of IOP but strength respiration inhibition.