氯瑞合剂对小儿全身静脉麻醉心血管系统影响.docVIP

氯瑞合剂对小儿全身静脉麻醉心血管系统影响 　【摘要】 目的：观察瑞芬太尼复合氯胺酮在小儿全身麻醉中对心血管系统的影响。方法：将80例ASAⅠ级~Ⅱ级患儿随机分为A、B两组，每组各40例。A组用氯胺酮静脉注射泵维持，B组用氯胺酮以及瑞芬太尼静脉注射泵维持。术中监测患儿血压、心率及SpO2，观察并记录术后苏醒时间和氯胺酮的用量。结果：A组患儿血压和心率与麻醉前相比差异有显著性（Plt;0.05），B组差异无显著性，两组患儿SpO2较麻醉前差异均无显著性；B组术中氯胺酮用量和复苏时间均明显少于A组（Plt;0.05）。结论：瑞芬太尼复合氯胺酮用于小儿全身麻醉能更有效地维持心血管系统稳定，是一种较安全的麻醉方法。 【关键词】 瑞芬太尼;氯胺酮;小儿静脉麻醉 　　The Effect of Remifentanil on Cardiovascular System in Pediatric General Anesthesia 　 Abstract: Objective To study the effect of remifentanil and ketamine on cardiovascular system in pediatric general anesthesia. Methods Eighty patients were divided into two groups randomly. Group A was maintained with continuous infusion of ketamine intravenously, and group B was maintained with remifentanil and ketamine pumping. The mean blood pressure, heart rate, and SpO2 were recorded perioperatively. The time of recovery from anesthesia and dosage of ketamine were also recorded. Results The mean blood pressure and heart rate in group A were higher significantly in and after operation than preoperative state. There was no difference of SpO2 in both groups perioperatively. The dosage of ketamine and recovery time were higher in group A than that in group B. Conclusion The anesthesia maintained with remifentanil and ketamine was more effective in keeping cardiovascular system stable, and more safer in pediatric general anesthesia. Key words: Remifentanil; Ketamine; Pediatric general anesthesia 氯胺酮已广泛应用于小儿手术的麻醉，但药量过大时副作用较多，而瑞芬太尼为新一代阿片类麻醉性镇痛药，其在体内经血浆和组织酯酶分解，作用时间短，可控性好，是全身静脉麻醉的理想药物［1］。我院自2005年2月至今采取瑞芬太尼复合氯胺酮持续输注麻醉维持，麻醉平稳，心血管系统稳定，现报告如下。 　　1 资料与方法 　　1.1 一般资料 　　ASAⅠ级~Ⅱ级手术患儿80例，其中男42例，女38例，年龄17 d~12岁，体重3.9 kg~30.5 kg。手术部位：颜面、颈部32例，肝肠17例，会阴、四肢31例。 　　1.2 麻醉方法 　　所有患儿均于麻醉前30 min肌肉注射地西泮0.2 mg/kg，阿托品0.02 mg/kg，不合作患儿肌注氯胺酮4 mg/kg，入眠后入手术室，开放静脉输液。取仰卧位，不行气管内插管，保留自主呼吸，面罩吸氧2 L/min。A组用氯胺酮［95±7.8 μg/(kg·min)］静脉注射泵维持，B组用微量泵输注“氯瑞”合剂(氯胺酮100 mg加瑞芬太尼0.1 mg加生理盐水20 ml)，前10 min注速5 ml/h~15 ml/h，随后维持在2 ml/h~9 ml/h，根据术中情况调节注药速度。 　　1.3 监测 　　麻醉及术中连续监测无创血压（MAP）、心电图（ECG）、心率（HR）、脉搏血氧饱和度（S