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目的:观察七氟醚与氯胺酮应用于室间隔缺损患儿麻醉诱导时的差异,以求找到更适合室间隔缺损患儿的诱导方法。方法:40例行室间隔修补术的3~6岁患儿,ASAⅠ~Ⅱ级,无神经系统及精神疾患,随机分为A、B两组,每组20例。A组诱导采用肌注氯胺酮6~8mg·kg-1,阿托品0.01~0.015mg·kg-1,待患儿意识消失后开放静脉,给予咪唑安定1mg,芬太尼10μg·kg-1,万可松0.8~1.0mg·kg-1,地塞米松2mg,气管插管。B组诱导采用面罩吸入七氟醚,待睫毛反射消失后开放静脉,给予芬太尼10μg·kg-1,万可松0.8~1.0mg·kg-1,地塞米松2mg,气管插管。记录各组患儿诱导时间,诱导时的顺从性评分、血流动力学变化及副反应,诱导后分泌物情况。结果:B组患儿的诱导顺从性评分、诱导时间及诱导后患儿分泌物重量B组均明显小于A组,P<0.01。A组患儿诱导后血压、心率显著升高(P<0.01)。B组患儿诱导后血压无明显变化(P>0.05);心率显著减慢(P<0.05)。B组患儿诱导后血压、心率均显著低于A组(P<0.01)。A组有2例患儿诱导时缺氧发作,B组患儿未见任何副反应发生。结论:对于室间隔缺损患儿,吸入七氟醚麻醉诱导明显优于肌注氯胺酮。
OBJECTIVE: To observe the difference of anesthetic induction of sevoflurane and ketamine in children with ventricular septal defect in order to find a more suitable inducing method for children with ventricular septal defect. Methods: Forty children aged 3 ~ 6 years old with ASA Ⅰ ~ Ⅱ grade without ventricular septal repair were randomly divided into two groups (A and B), 20 cases in each group. In group A, intramuscular injection of ketamine (6-8 mg · kg-1) and atropine (0.01-0.015 mg · kg-1) were induced. When the consciousness of the children disappeared, the vein was opened and 1 mg of midazolam and 10 μg · kg-1 of fentanyl Loose 0.8 ~ 1.0mg · kg-1, dexamethasone 2mg, tracheal intubation. In group B, sevoflurane was inhaled with a mask, and the vein was opened after the reflex of eyelashes disappeared. The patients were given fentanyl 10μg · kg-1, Wanokong 0.8 ~ 1.0mg · kg-1, dexamethasone 2mg and tracheal intubation. The induction time of each group, compliance score at induction, hemodynamic changes, side effects and secretions after induction were recorded. Results: The scores of induction compliance, induction time and weight of secretions of children in group B were significantly less than those in group A (P <0.01). A group of children after induction of blood pressure, heart rate was significantly increased (P <0.01). No significant changes in blood pressure were observed in group B (P> 0.05); heart rate was significantly decreased (P <0.05). After induction, the blood pressure and heart rate in group B were significantly lower than those in group A (P <0.01). A group of 2 patients induced hypoxia induced seizures, B group did not have any side effects occurred in children. Conclusions: In children with ventricular septal defect, induction of sevoflurane anesthesia is significantly better than intramuscular injection of ketamine.