异丙酚加芬太尼辅助硬膜外麻醉在小儿阑尾手术中应用.doc

异丙酚加芬太尼辅助硬膜外麻醉在小儿阑尾手术中应用[摘要] 目的：研究异丙酚加芬太尼辅助硬膜外麻醉在小儿阑尾手术中的应用，并与咪唑安定加氯胺酮进行比较。方法：将60例阑尾炎患儿随机分为两组，Ⅰ组采用异丙酚加芬太尼，Ⅱ组采用咪唑安定加氯胺酮，分别记录麻醉前、麻醉后l、5、10、15 min的RR(呼吸频率)、HR(心率)、Sp02(氧饱和度)、MAP(平均动脉压)、术后清醒时间(睁眼和清楚应答)、术后24 h内恶心、呕吐的发生率。结果：两组麻醉后1、5、l0、15 min，HR、RR变化有显著性差异(P＜0.05)，SpO2、MAP无显著差异，Ⅰ组术后无躁动，恶心、呕吐1例，Ⅱ组术后躁动4例，恶心、呕吐6例。结论：异丙酚加芬太尼辅助硬膜外麻醉在小儿阑尾手术中比氯胺酮加咪唑安定更具优越性。 [关键词] 异丙酚；芬太尼；硬膜外麻醉 [中图分类号] R614 [文献标识码]A [文章编号]1673-7210（2008）02（c）-039-02 The clinical application of propofol combined with fentanyl to assist epidural anesthesia in pedo-appendix intraoperative WANG Jian-ke （Department of Anesthesiology, the People＇s Hospital of Dangyang,Hubei Province, Dangyang 444100,China） [Abstract] Objective:To study the clinical application of propofol combined with fentanyl to assist epidural anesthesia in pedo-appendix intraoperative, and compared with midazolam combined with ketamine.Methods:To divide the sixty appendicitis children into two groups , propofol combinedwith fentanyl and midazolam combined with ketamine, record the 1 min，5 min，10 min，15 min RR,HR, Sp02,MAP, after-operative consciousness time ,the rate of nausea and vomitory in the fore-anesthesia and after-anesthesia.Results: The 1,5,10,15 min RR and HR in the after-anesthesia of th two groups indicated significant difference(P＜0.05), Sp02 and MAP indicated no significant difference. There has been no restlessness in the group of propofol combined with fentanyl after operation, but four in the group of midazolam combined with ketamine. The rate of nausea and vomitory of the two groups were one and six. Conclusion:Propofol combined with fentanyl to assist epidural anesthesia in pedo-appendix intraoperative indicate more superiority than midazolam combined with ketamine. [Key words]Propofol;Fentanyl;Epidural anesthesia 异丙酚是一种新型的真正的短作用时间的静脉麻醉药，它几乎能够完全符合静脉麻醉药的“黄金标准”，因此在小儿麻醉中被广泛接受。芬太尼具有较强的镇痛作用。为此，笔者研究了异丙酚加芬太尼辅助小儿硬膜外麻醉的优越性，并与咪唑安定加氯胺酮比较。 1 资料和方法 1.1 一般资料 60例年龄7～11岁患儿，男性40例，女性22例，均为阑尾切除手术。手术时间20～40 min，选用Tl2