中国医药
中國醫藥
중국의약
CHINA MEDICINE
2013年
1期
102-104
,共3页
结肠镜检查%丙泊酚%氯胺酮%麻醉和镇痛
結腸鏡檢查%丙泊酚%氯胺酮%痳醉和鎮痛
결장경검사%병박분%록알동%마취화진통
Colonoscopy%Propofol%Ketamine%Anesthesia and analgesia
目的 观察氯胺酮复合丙泊酚静脉麻醉在小儿无痛全结肠镜中的麻醉效果.方法 将行无痛全结肠镜检查患儿200例完全随机分为观察组和对照组,各100例.观察组:静脉注射氯胺酮1 mg/kg后,再缓慢静脉注射丙泊酚1 ～3 mg/kg(从1 mg/kg开始逐步递增直至睫毛反射消失).对照组:静脉注射丙泊酚1 ～3 mg/kg.待患儿安静入睡,睫毛反射消失后开始进镜,术中根据不引起体动反应,方便术者操作,维持恰当的麻醉深度和正常的生命体征来适时追加丙泊酚.监测2组患儿麻醉前(T0)、麻醉后进镜前(T1)、进镜时(T2)、检查结束时(T3)及苏醒时(T4)时的平均动脉压(MAP)、HR、脉搏血氧饱和度(SpO2)和呼吸的变化；记录麻醉诱导时间、手术时间、苏醒时间、丙泊酚的用量、阿托品和麻黄碱使用情况.记录术中体动反应、低氧血症、心动过缓、低血压、肌阵挛及术后有关并发症的发生情况.结果 观察组T0、T1、T2、T3及T4时的MAP分别为(68±9)、(64±8)、(60±8)、(62±8)、(64 ±9)mm Hg(1 mm Hg =0.133 kPa),对照组T0、T1、T2、T3及T4时的MAP分别为(65±8)、(57±6)、(55±6)、(56±6)、(59±8)mm Hg;观察组T0、T1、T2、T3及T4时的HR分别为(92±8)、(89±7)、(85±8)、(86±8)、(86±9)次/min,对照组T0、T1、T2、T3及T4时的HR分别为(89±6)、(86±6)、(81±6)、(84±6)、(87±7)次/min;2组患儿麻醉后各时间点MAP、HR比麻醉前均降低,组间差异有统计学意义(P＜0.05)；对照组T2时MAP降低更明显,与观察组同时间点比较差异有统计学意义(P＜0.05).2组患儿麻醉后各时间点SpO2无变化,组间差异无统计学意义(P＞0.05).观察组T0、T1、T2时呼吸频率分别为(23.1±4.2)、(20.7±4.1)、(18.5±2.4)次/min,对照组T0、T1、T2时呼吸频率分别为(22.2±3.8)、(20.4±3.8)、(17.5±4.1)次/min,2组患儿T1、T2时的呼吸频率与麻醉前比较差异均有统计学意义(P＜0.05)；对照组T1、T2时呼吸频率与观察组同时间点比较差异均有统计学意义(均P＜0.05).与对照组比较,观察组低血压发生率降低,组间差异有统计学意义[52.0％ (52/100)比67.0％(67/100),P＜0.05].结论 氯胺酮复合丙泊酚用于小儿无痛肠镜检查对呼吸和循环影响轻,术中及术后并发症发生率低.
目的 觀察氯胺酮複閤丙泊酚靜脈痳醉在小兒無痛全結腸鏡中的痳醉效果.方法 將行無痛全結腸鏡檢查患兒200例完全隨機分為觀察組和對照組,各100例.觀察組:靜脈註射氯胺酮1 mg/kg後,再緩慢靜脈註射丙泊酚1 ～3 mg/kg(從1 mg/kg開始逐步遞增直至睫毛反射消失).對照組:靜脈註射丙泊酚1 ～3 mg/kg.待患兒安靜入睡,睫毛反射消失後開始進鏡,術中根據不引起體動反應,方便術者操作,維持恰噹的痳醉深度和正常的生命體徵來適時追加丙泊酚.鑑測2組患兒痳醉前(T0)、痳醉後進鏡前(T1)、進鏡時(T2)、檢查結束時(T3)及囌醒時(T4)時的平均動脈壓(MAP)、HR、脈搏血氧飽和度(SpO2)和呼吸的變化；記錄痳醉誘導時間、手術時間、囌醒時間、丙泊酚的用量、阿託品和痳黃堿使用情況.記錄術中體動反應、低氧血癥、心動過緩、低血壓、肌陣攣及術後有關併髮癥的髮生情況.結果 觀察組T0、T1、T2、T3及T4時的MAP分彆為(68±9)、(64±8)、(60±8)、(62±8)、(64 ±9)mm Hg(1 mm Hg =0.133 kPa),對照組T0、T1、T2、T3及T4時的MAP分彆為(65±8)、(57±6)、(55±6)、(56±6)、(59±8)mm Hg;觀察組T0、T1、T2、T3及T4時的HR分彆為(92±8)、(89±7)、(85±8)、(86±8)、(86±9)次/min,對照組T0、T1、T2、T3及T4時的HR分彆為(89±6)、(86±6)、(81±6)、(84±6)、(87±7)次/min;2組患兒痳醉後各時間點MAP、HR比痳醉前均降低,組間差異有統計學意義(P＜0.05)；對照組T2時MAP降低更明顯,與觀察組同時間點比較差異有統計學意義(P＜0.05).2組患兒痳醉後各時間點SpO2無變化,組間差異無統計學意義(P＞0.05).觀察組T0、T1、T2時呼吸頻率分彆為(23.1±4.2)、(20.7±4.1)、(18.5±2.4)次/min,對照組T0、T1、T2時呼吸頻率分彆為(22.2±3.8)、(20.4±3.8)、(17.5±4.1)次/min,2組患兒T1、T2時的呼吸頻率與痳醉前比較差異均有統計學意義(P＜0.05)；對照組T1、T2時呼吸頻率與觀察組同時間點比較差異均有統計學意義(均P＜0.05).與對照組比較,觀察組低血壓髮生率降低,組間差異有統計學意義[52.0％ (52/100)比67.0％(67/100),P＜0.05].結論 氯胺酮複閤丙泊酚用于小兒無痛腸鏡檢查對呼吸和循環影響輕,術中及術後併髮癥髮生率低.
목적 관찰록알동복합병박분정맥마취재소인무통전결장경중적마취효과.방법 장행무통전결장경검사환인200례완전수궤분위관찰조화대조조,각100례.관찰조:정맥주사록알동1 mg/kg후,재완만정맥주사병박분1 ～3 mg/kg(종1 mg/kg개시축보체증직지첩모반사소실).대조조:정맥주사병박분1 ～3 mg/kg.대환인안정입수,첩모반사소실후개시진경,술중근거불인기체동반응,방편술자조작,유지흡당적마취심도화정상적생명체정래괄시추가병박분.감측2조환인마취전(T0)、마취후진경전(T1)、진경시(T2)、검사결속시(T3)급소성시(T4)시적평균동맥압(MAP)、HR、맥박혈양포화도(SpO2)화호흡적변화；기록마취유도시간、수술시간、소성시간、병박분적용량、아탁품화마황감사용정황.기록술중체동반응、저양혈증、심동과완、저혈압、기진련급술후유관병발증적발생정황.결과 관찰조T0、T1、T2、T3급T4시적MAP분별위(68±9)、(64±8)、(60±8)、(62±8)、(64 ±9)mm Hg(1 mm Hg =0.133 kPa),대조조T0、T1、T2、T3급T4시적MAP분별위(65±8)、(57±6)、(55±6)、(56±6)、(59±8)mm Hg;관찰조T0、T1、T2、T3급T4시적HR분별위(92±8)、(89±7)、(85±8)、(86±8)、(86±9)차/min,대조조T0、T1、T2、T3급T4시적HR분별위(89±6)、(86±6)、(81±6)、(84±6)、(87±7)차/min;2조환인마취후각시간점MAP、HR비마취전균강저,조간차이유통계학의의(P＜0.05)；대조조T2시MAP강저경명현,여관찰조동시간점비교차이유통계학의의(P＜0.05).2조환인마취후각시간점SpO2무변화,조간차이무통계학의의(P＞0.05).관찰조T0、T1、T2시호흡빈솔분별위(23.1±4.2)、(20.7±4.1)、(18.5±2.4)차/min,대조조T0、T1、T2시호흡빈솔분별위(22.2±3.8)、(20.4±3.8)、(17.5±4.1)차/min,2조환인T1、T2시적호흡빈솔여마취전비교차이균유통계학의의(P＜0.05)；대조조T1、T2시호흡빈솔여관찰조동시간점비교차이균유통계학의의(균P＜0.05).여대조조비교,관찰조저혈압발생솔강저,조간차이유통계학의의[52.0％ (52/100)비67.0％(67/100),P＜0.05].결론 록알동복합병박분용우소인무통장경검사대호흡화순배영향경,술중급술후병발증발생솔저.
Objective To obeserve the efficacy of ketamine combined with propofol for children painless colonoscopy.Methods Totally 200 children undergoing painless colonoscopy were randomly allocated into observation group and control group.Observation group was given ketamine 1 mg/kg and then propofol 1-3 mg/kg until disappearance of eyelash reflex.Control group was given propofol 1-3 mg/kg.colonoscopy was performed until disappearance of eyelash reflex.Additional propofol was given according to the response to surgical stimuli,depth of anesthesia and convenience of the operaters.Mean arterial pressure (MAP),pulse oxygen saturation(SpO2),heart rate(HR) and respiration rate (RR) were continously monitored and recorded before anesthesia (T0),before colonoscopy intubation(T1),during Colonoscopy intubation(T2),at the end of operation(T3)and the time of wake up(T4).The anesthesia induction time,colonoscopy time,the amount of propofol administered,the number of cases who used atropine and ephedrine,the anesthetic efficacy assessed by anesthetist and endoscopist and recovery time were recorded.In addition intraoperative body movement,apnea,hypoxemia,bradycardia,hypotension,myoclonus,injection pain and postoperative complications were also recorded.Results In observation group,MAP was (68 ± 9) mm Hg,(64 ± 8) mm Hg,(60 ± 8)mm Hg,(62 ± 8) mm Hg,(64 ± 9) mm Hg respectively in T0,T1,T2,T3 and T4.In control group,MAP was (65 ±8)mm Hg,(57 ±6)mm Hg,(55 ±6)mm Hg,(56 ±6)mm Hg and (59 ± 8) mm Hg respectively in T0,T1,T2,T3 and T4.In observation group,HR was (92 ± 8) times/min,(89 ± 7) times/min,(85 ± 8) times/min,(86 ± 8) times/min and (86 ± 9) times/min respectively in T0,T1,T2,T3 and T4.In control group,HR was (89 ± 6) times/min,(86 ± 6) times/min,(81 ± 6) times/min,(84 ±6) times/min and (87 ± 7)times/min respectively in T0,T1,T2,T3 and T4.Compared with T0,MAP and HR of two groups in T1 were decreased (P ＜ 0.05).In two groups,SpO2 were not effected in T0 to T4 (P ＞ 0.05).In observation group,RR were (23.1 ± 4.2) times/min,(20.7 ± 4.1) times/min,(18.5 ± 2.4) times/min respectively in T0,T1,T2.In control group,RR was (22.2 ± 3.8) times/min,(20.4 ± 3.8) times/min,(17.5 ±4.1) times/min respectively in T0,T1,T2.Compared with T0,RR of two groups was decreased significantly (P ＜0.05).In control group,RR was decreased much more in T1,T2.Compared with control group,hypotension in observation group was significantly reduced [52.0％ (52/100) vs 67.0％ (67/100),P ＜ 0.05].Conclusions Ketamine combined with propofol has little inhibitory effect on circulatory and respiratory function in children undergoing colonoscopy.
