CAJ | 학술논문

【目的】比较超声引导神经阻滞联合右美托咪定与氯胺酮静脉全麻在小儿腹股沟区手术应用的优缺点。【方法】选择ASAⅠ～Ⅱ级择期行单侧腹股沟区手术患儿40例，随机分为两组。右美托咪定组（D组）予以右美托咪定负荷剂量1μg／kg 15 min静脉泵入和丙泊酚2．0～2．5 mg／kg诱导，行超声引导下髂腹股沟／髂腹下神经阻滞，然后右美托咪定0．2～0．7μg／（kg · h）和丙泊酚4～6 mg／（kg · h）维持；氯胺酮组（K组）予以氯胺酮1 mg／kg诱导和0．5 mg／（kg · h）维持，丙泊酚用法同D组。记录两组患儿麻醉诱导前后、手术切皮时、苏醒时的心率（HR），平均动脉压（MAP），心电图（ECG），呼吸频率（RR）及脉搏血氧饱和度（SpO2）；术中及术后不良反应并采取相应措施处理；对小儿术后进行行为学的面部表情评分（FLACC）以及恢复室麻醉医生和患儿家属的满意度评估。【结果】D组患儿在麻醉诱导后 HR较K组明显降低（ P ＜0．05）；D组患儿苏醒时间明显长于K组（P ＜0．05）；D组在苏醒期、术后2h、4h的疼痛评分均低于K组（P ＜0．05）；D组患儿家属满意度评分高于K组（P ＜0．05），两组恢复室医生满意度评分比较，差异无统计学意义；D组1例，K 组6例患儿术后出现躁动（P ＜0．05）。【结论】超声引导神经阻滞联合右美托咪定应用于小儿腹股沟区手术能减轻患儿术后躁动及术后疼痛，麻醉质量及安全性高，且获得患儿家属较高认可，值得在小儿麻醉中推广应用。
【목적】비교초성인도신경조체연합우미탁미정여록알동정맥전마재소인복고구구수술응용적우결점。【방법】선택ASAⅠ～Ⅱ급택기행단측복고구구수술환인40례，수궤분위량조。우미탁미정조（D조）여이우미탁미정부하제량1μg／kg 15 min정맥빙입화병박분2．0～2．5 mg／kg유도，행초성인도하가복고구／가복하신경조체，연후우미탁미정0．2～0．7μg／（kg · h）화병박분4～6 mg／（kg · h）유지；록알동조（K조）여이록알동1 mg／kg유도화0．5 mg／（kg · h）유지，병박분용법동D조。기록량조환인마취유도전후、수술절피시、소성시적심솔（HR），평균동맥압（MAP），심전도（ECG），호흡빈솔（RR）급맥박혈양포화도（SpO2）；술중급술후불량반응병채취상응조시처리；대소인술후진행행위학적면부표정평분（FLACC）이급회복실마취의생화환인가속적만의도평고。【결과】D조환인재마취유도후 HR교K조명현강저（ P ＜0．05）；D조환인소성시간명현장우K조（P ＜0．05）；D조재소성기、술후2h、4h적동통평분균저우K조（P ＜0．05）；D조환인가속만의도평분고우K조（P ＜0．05），량조회복실의생만의도평분비교，차이무통계학의의；D조1례，K 조6례환인술후출현조동（P ＜0．05）。【결론】초성인도신경조체연합우미탁미정응용우소인복고구구수술능감경환인술후조동급술후동통，마취질량급안전성고，차획득환인가속교고인가，치득재소인마취중추엄응용。
[Objective] To evaluate the efficacy of ultrasound guidance for ilioinguinal oriliohypogastfie nerve block plus dexmedetomidine or ketamine anesthesia during pediatric outpatient inguinal surgery .[Methods] The present study was ap‐proved by the ethics committee of our hospital .Forty children with ASA statusⅠ ~ Ⅱ ,aged (1~6) years old ,scheduled for unilateral inguinal surgery were divided randomly into dexmedetomidine (D) and ketamine (K) groups ( n = 20 each) .The dexmedetomidine plus propofol group (group D) received an infusion over 15 minutes of 1 μg/kg dexmedetomidine and propo‐fol ,(2 .0~2 .5) mg/kg ,as a bolus for induction .Then Group D received an ilioinguinal or iliohypogastric block under ultra‐sonic guidance and an infusion of (0 .2~0 .7)μg/(kg · h) dexmedetomidine and (4~6) mg/(kg · h) propofol for maintenance . The ketamine plus propofol group (group K) received (2 .0~2 .5) mg/kg propofol and 1 mg/kg ketamine for induction and (4~6) mg/(kg · h) propofol and 0 .5 mg/(kg · h) ketamine by infusion for maintenance .Upon entering operation room ,they were monitored by electrocardiography (ECG) ,heart rate (HR) ,respiratory rate (RR) and oxygen saturation (SpO2 ) .Face legs activity cry consolability (FLACC) score was used to assess pain scores postoperatively at recovery time ,2h and 4h posto‐peration respectively .The degrees of parent and doctor's satisfaction were gauged at 2h and 4 h postoperation .And peripostop‐erative adverse events were also recorded .[Results] HR was significantly lower in group D after induction than that in group K ( P <0 .05) .The recovery time was longer in group D than that in group K ( P<0 .05) .The pain scores at recovery time ,2h and 4 h postoperation in group D was significantly lower than those in group K ( P<0 .05) .The degree of parental satisfaction was significantly higher in group D than that in group K ( P<0 .05) .[Conclusion] The method of ultrasonic guidance for ilio‐inguinal or iliohypogastric nerve block plus dexmedetomidine is both feasible and efficacious .