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目的观察七氟醚与氯胺酮应用于扁桃体切除患儿麻醉诱导时的差异,以求找到更适合扁桃体切除患儿的诱导方法。方法40例行扁桃体切除术患儿,ASAⅠ-Ⅱ级,无慢性疾病、早产史及发育延迟,无神经系统及精神疾患,随机分为A、B两组,每组20例。A组诱导采用肌内注射氯胺酮6~8 mg.kg-1,阿托品0.01~0.015 mg.kg-1,待患儿意识消失后开放静脉;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。开放静脉后,所有患儿给予芬太尼2μg.kg-1,万可松0.8~1.0 mg.kg-1,异丙酚0.2~0.3 mg.kg-1,气管插管。记录各组患儿诱导时间,诱导时的顺从性评分,诱导后分泌物情况及其他不良反应。采用焦虑自评量表测量患儿家长术前1 d及与患儿分离后的焦虑评分。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。两组患儿家长术前焦虑程度差异无显著统计学意义,P>0.05。与患儿分离后焦虑程度均显著增高,P<0.01,且A组显著高于B组,P<0.05。结论对于行扁桃体切除术的患儿,吸入七氟醚麻醉诱导明显优于肌内注射氯胺酮。
Objective To observe the difference of anesthesia induced by sevoflurane and ketamine in children with tonsillectomy in order to find a more suitable induction method for children with tonsillectomy. Methods Forty children undergoing tonsillectomy, ASA Ⅰ-Ⅱ grade, no chronic diseases, premature delivery history and delayed development, without nervous system and mental disorders were randomly divided into A and B groups, 20 cases in each group. In group A, 6-8 mg.kg-1 of ketamine and 0.01-0.015 mg.kg-1 of atropine were intramuscularly injected. When the consciousness of the children disappeared, the veins were opened. Group B was induced to inhale sevoflurane with mask, After opening the vein. After opening the veins, all children were given fentanyl 2μg.kg-1, wolfone 0.8 ~ 1.0 mg.kg-1, propofol 0.2 ~ 0.3 mg.kg-1, intubation. The induction time, induction compliance score, post-induction secretion and other adverse reactions were recorded in each group. The Anxiety Scale was used to measure the anxiety score of the children 1 d preoperatively and separated from the children. Results B group of children’s compliance score, induction time and induced secretion of children’s weight B group were significantly less than A group, P <0.01. There was no significant difference in preoperative anxiety between two groups of children (P> 0.05). The degree of anxiety was significantly higher after separation from the children, P <0.01, and the A group was significantly higher than the B group, P <0.05. Conclusion In children undergoing tonsillectomy, induction of sevoflurane anesthesia was significantly better than intramuscular injection of ketamine.