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目的:观察采用亚麻醉剂量氯胺酮-芬太尼辅助小儿区域麻醉的麻醉及术后镇痛效果。方法:随机选择2010-01至2012-01于我院进行腹部及四肢手术,年龄在5-15岁的患儿150例,进行回顾性研究,全部患儿均采用氯胺酮进行基础麻醉,A组50例患儿均为上肢手术,先采用肌肉注射亚麻醉剂量氯胺酮(2-6mg/kg),然后静脉缓慢小剂量芬太尼,B组患儿50例均为腹部和下肢手术,采用椎管内氯胺酮及芬太尼亚麻醉剂量麻醉。C组患儿50例整个手术过程中均采用氯胺酮连续麻醉。分别记录各组患儿麻醉前5min、麻醉后10min、麻醉后30min呼吸频率(RR)、平均动脉压(MAP)、心率(HR)、脉搏氧饱和度(SpO2)及手术时间、唤醒时间、药物用量、麻醉效能参数、术后不良反应等指标。结果:三组患儿麻醉起效前HR、MAP、RR、SpO2四项生命体征,不存在统计学差异(p>0.05),麻醉起效后10min、30min时A、B两组HR、MAP、RR三项指标均优于C组,差异存在统计意义(p<0.05),但前两组SpO2值低于C组,差异存在统计学意义(p<0.05)。结论:亚麻醉剂量氯胺酮及芬太尼联合使用能够减少前者用量,降低其蓄积作用对患儿影响,同时增强麻醉及镇痛效能,减少麻醉起效及唤醒时间,但必须密切监测患儿呼吸功能。
Objective: To observe the effects of anesthesia and postoperative analgesia using sub-anesthetic ketamine-fentanyl in children’s regional anesthesia. Methods: A total of 150 children aged 5-15 years old with abdominal and limb surgery in our hospital from January 2010 to January 2012 were retrospectively studied. All children received basic anesthesia with ketamine. Group A The patients were all undergoing upper limb surgery. First, intramuscular injection of ketamine (2-6 mg / kg) was given and then a slow intravenous bolus of fentanyl. All the 50 children in group B underwent abdominal and lower limb surgery. Ketamine and fentanyl anesthesia. Fifty children in group C were treated with continuous ketamine for the entire procedure. Respiratory rate (RR), mean arterial pressure (MAP), heart rate (HR), pulse oxygen saturation (SpO2) and time of operation, awakening time, and drug release were recorded at 5 min before anesthesia, 10 min after anesthesia and 30 min after anesthesia in each group. Dosage, anesthesia performance parameters, postoperative adverse reactions and other indicators. Results: There was no significant difference in the four vital signs of HR, MAP, RR and SpO2 before anesthesia onset in three groups (p> 0.05). HR, MAP, RR were better than those in group C (P <0.05), but the values of SpO2 in the two groups were lower than those in group C (p <0.05). Conclusion: The combination of ketamine and fentanyl in sub-anesthetic dose can reduce the former dosage, reduce the effect of its accumulation on children, enhance anesthesia and analgesic efficacy, reduce onset of anesthesia and awakening time, but closely monitor respiratory function .