CAJ | 학술논문

目的评价不同剂量右美托咪定复合氯胺酮用于患儿室间隔缺损封堵术的麻醉效果.方法选择需介入治疗的室间隔缺损患儿90例,年龄4～11岁,体重12 ～ 47 kg,ASA分级Ⅰ或Ⅱ级,采用随机数字表法,将其分为3组(n=30):D1组、D2组和D3组.入室后静脉注射阿托品0.02 mg/kg和氯胺酮1.0 mg/kg麻醉诱导,随后给予右美托咪定负荷量0.5 μg/kg,10 min输注完毕,然后D1组、D2组、D3组分别静脉输注右美托咪定0.7、1.0、1.2 μg·kg-1 ·h-1至术毕,患儿意识消失后行股动脉穿刺并介入治疗.术中有体动等麻醉变浅情况单次追加氯胺酮0.5 mg/kg.于入室(T0)、氯胺酮给药后1min(T1)、5 min(T2)、右美托咪定负荷量输注完毕即刻(T3)、输注维持量后15 min(T4)、术毕即刻(T5)、苏醒即刻(T6)记录BIS值、BP、HR和SpO2,记录氯胺酮总用量、氯胺酮和阿托品追加情况、手术时间、苏醒时间、呼吸抑制和术后躁动等不良反应的发生情况.结果与T0时比较,T4.5时3组BIS值降低,D2组和D3组HR降低(P＜0.05),3组BP和SpO2各时点差异无统计学意义(P＞0.05).与D1组比较,D2组和D3组阿托品追加率升高,氯胺酮总用量减少,氯胺酮追加率和呼吸抑制的发生率降低(P＜0.05).D2组和D3组氯胺酮追加率为0.与D2组比较,D3组阿托品追加率升高(P＜0.05).3组手术时间和苏醒时间比较差异无统计学意义(P＞0.05).所有患儿均未见苏醒期躁动发生.结论患儿室间隔缺损封堵术中采用氯胺酮1.0 mg/kg麻醉诱导,继以右美托咪定0.5 μg/kg负荷、1.0μg·kg-1 ·h-1维持可产生良好的麻醉效果,且不良反应少,是较适宜的麻醉组合.
목적 평개불동제량우미탁미정복합록알동용우환인실간격결손봉도술적마취효과.방법 선택수개입치료적실간격결손환인90례,년령4～11세,체중12 ～ 47 kg,ASA분급Ⅰ혹Ⅱ급,채용수궤수자표법,장기분위3조(n=30):D1조、D2조화D3조.입실후정맥주사아탁품0.02 mg/kg화록알동1.0 mg/kg마취유도,수후급여우미탁미정부하량0.5 μg/kg,10 min수주완필,연후D1조、D2조、D3조분별정맥수주우미탁미정0.7、1.0、1.2 μg·kg-1 ·h-1지술필,환인의식소실후행고동맥천자병개입치료.술중유체동등마취변천정황단차추가록알동0.5 mg/kg.우입실(T0)、록알동급약후1min(T1)、5 min(T2)、우미탁미정부하량수주완필즉각(T3)、수주유지량후15 min(T4)、술필즉각(T5)、소성즉각(T6)기록BIS치、BP、HR화SpO2,기록록알동총용량、록알동화아탁품추가정황、수술시간、소성시간、호흡억제화술후조동등불량반응적발생정황.결과 여T0시비교,T4.5시3조BIS치강저,D2조화D3조HR강저(P＜0.05),3조BP화SpO2각시점차이무통계학의의(P＞0.05).여D1조비교,D2조화D3조아탁품추가솔승고,록알동총용량감소,록알동추가솔화호흡억제적발생솔강저(P＜0.05).D2조화D3조록알동추가솔위0.여D2조비교,D3조아탁품추가솔승고(P＜0.05).3조수술시간화소성시간비교차이무통계학의의(P＞0.05).소유환인균미견소성기조동발생.결론 환인실간격결손봉도술중채용록알동1.0 mg/kg마취유도,계이우미탁미정0.5 μg/kg부하、1.0μg·kg-1 ·h-1유지가산생량호적마취효과,차불량반응소,시교괄의적마취조합.
Objective To evaluate the anesthetic efficacy of different doses of dexmedetomidine combined with ketamine in the pediatric patients undergoing closure of ventricular septal defect.Methods Ninety pediatric patients with ventricular septal defect requiring interventional treatment,aged 4-11 yr,weighing 12-47 kg,of ASA physical status Ⅰ or Ⅱ,were randomly divided into D1-3 groups (n =30 each) using a random number table.After admission to operating room,anesthesia was induced with iv atropine 0.02 mg/kg and ketamine 1.0 mg/kg,followed by administration of a loading dose of dexmedetonidine 0.5 μg/kg which was infused over 10 min.In D1,D2 and D3 groups,dexmedetomidine 0.7,1.0 and 1.2 μg· kg 1 · h-1 were infused intravenously,respectively,until the end of operation.After the pediatric patients lost consciousness,the femoral artery was punctured to perform interventional treatment.Additional ketamine 0.5 mg/kg was given when the depth of anesthesia was inadequate.BIS,BP,HR and SpO2 were recorded after admission to the operating room (T0),at 1 and 5 min after ketamine administration (T1,2),at the end of loading dose of dexmedetomidine infusion (T3),at 15 min after maintenance dose of dexmedetomidine infusion (T4),immediately after operation (T5),and immediately after emergence (T6).The total consumption of ketamine,cases who needed additional ketamine and atropine,operation time,emergence time and development of adverse effects such as respiratory depression and postoperative agitation were recorded.Results Compared with the baseline value at T0,BIS value was significantly decreased at T4,5 in the three groups,HR was decreased at T4,5 in D2,3 groups,and no significant change was found in BP and SpO2 at each time point in the three groups.Compared with D1 group,the requirement for additional atropine was significantly increased,the total consumption of ketamine was reduced,and the requirement for additional ketamine and incidence of respiratory depression were decreased in D2 and D3 groups.No patients needed additional ketamine in D2 and D3 groups.The requirement for additional atropine was significantly higher in D3 group than in D2 group.There was no significant difference in the operation time and emergence time among the three groups.No pediatric patients developed agitation during emergence from anesthesia.Conclusion Ketamine 1.0 mg/kg (for induction of anesthesia) combined with a loading dose of dexmedetomidine 0.5 μg/kg and maintenance dose of dexmedetomidine 1.0 μg·kg-1 · h-1 (for maintenance of anesthesia) can produce good anesthetic efficacy,which is an optimum combination of anesthesia in pediatric patients undergoing closure of ventricular septal defect.