CAJ | 학술논문

目的研究氯胺酮复合布托啡诺静脉麻醉在小儿日间手术中应用的临床效果.方法选择美国麻醉医师协会(ASA)分级Ⅰ或Ⅱ级行腹股沟疝修补术、包皮环切术的患儿(1岁～6岁)200例,按随机数字表法分为2组(每组100例):氯胺酮复合生理盐水组(KS组)和氯胺酮复合布托啡诺组(KB组).KS组患儿静脉给予氯胺酮2 mg/kg复合生理盐水2 ml行麻醉诱导,KB组患儿则给予氯胺酮2 mg/kg复合2 ml含有30 μg/kg的布托啡诺,若患儿术中出现明显的体动反应,则静脉追加氯胺酮1 mg/kg.记录呼吸、血流动力学变化、苏醒时间、术后CHEOPS疼痛评分(术后即刻、术后1、2、4、8、12、24 h)和镇静评分(术后15、30、60 min)及氯胺酮用量.结果 KB组的氯胺酮用量(42.2±12.9) mg较KS组(75.0±25.3) mg明显减少;且术后平均CHEOPS评分显著降低、术后镇静评分显著较高;麻醉后复苏室内苏醒时间显著延长(P ＜0.05),但并不延长出室时间.两组患儿的呼吸与血流动力指标差异无统计学意义.结论氯胺酮复合布托啡诺静脉麻醉能够安全应用于小儿日间手术,减少大剂量氯胺酮所致的副作用,又可以提供较为完善的镇痛与镇静作用,减少小儿苏醒期躁动的发生.
목적 연구록알동복합포탁배낙정맥마취재소인일간수술중응용적림상효과.방법 선택미국마취의사협회(ASA)분급Ⅰ혹Ⅱ급행복고구산수보술、포피배절술적환인(1세～6세)200례,안수궤수자표법분위2조(매조100례):록알동복합생리염수조(KS조)화록알동복합포탁배낙조(KB조).KS조환인정맥급여록알동2 mg/kg복합생리염수2 ml행마취유도,KB조환인칙급여록알동2 mg/kg복합2 ml함유30 μg/kg적포탁배낙,약환인술중출현명현적체동반응,칙정맥추가록알동1 mg/kg.기록호흡、혈류동역학변화、소성시간、술후CHEOPS동통평분(술후즉각、술후1、2、4、8、12、24 h)화진정평분(술후15、30、60 min)급록알동용량.결과 KB조적록알동용량(42.2±12.9) mg교KS조(75.0±25.3) mg명현감소;차술후평균CHEOPS평분현저강저、술후진정평분현저교고;마취후복소실내소성시간현저연장(P ＜0.05),단병불연장출실시간.량조환인적호흡여혈류동력지표차이무통계학의의.결론 록알동복합포탁배낙정맥마취능구안전응용우소인일간수술,감소대제량록알동소치적부작용,우가이제공교위완선적진통여진정작용,감소소인소성기조동적발생.
Objective To compare the effects of ketamine combined with butorphanol for intravenous anesthesia with ketamine separately for pediatric day surgery.Methods In this double-blind trial,200 pediatric patients (ASA physical status 1 or 2,1 to 6 years old) undergoing inguinal hernia repair or circumcisions undergoing intravenous anesthesia were randomly allocated into two groups.Intravenous anesthesia was induced with 2 mg/kg ketamine combined with 2 ml saline (group KS,n=100) or 2 mg/ kg ketamine combined with 30 μg/kg butorphanol in the volume of 2 ml respectively (group KB,n=100).Repeat doses of ketamine 1 mg/kg were administered when the patients had motor responses.Total dosage of ketamine,variation of circulation and breath,awaken time were observed.Agitation and pain were assessed with sedative score and CHEOPS score respectively.The patients' parents were interviewed 24 h after surgery,and the adverse events were recorded.Results Group KB showed less consumption of ketamine (42.2±12.9) mg vs (75.0±25.3) mg (P＜0.05).Furthermore,the mean level of postoperative CHEOPS score and sedative score in the group KB was significantly lower than that in the group KS (P＜0.05).Awaken time was statistically longer in the group KS (P＜0.05),but the time spent in the PACU was similar in both groups.There was no significantly airway or hemodynamic effects observed in both groups.Conclusions Ketamine combined with butorphanol for pediatric day surgery is an ideal anesthesia and it has advantages such as safty,low dosage of keatmine to eliminate the adverse effect,providing a more comprehensive sedative and analgesic effect to reduce emergence agitation and postoperative pain in pediatric day surgery.