摘要
目的探讨氯胺酮与瑞芬太尼在小儿眼科喉罩置入全身麻醉手术中的应用效果。方法回顾性选取2020年7月至2023年5月在张家口市第四医院行眼科喉罩置入全身麻醉手术的68例患儿,分成氯胺酮组34例(实施氯胺酮联合丙泊酚麻醉)和瑞芬太尼组34例(实施丙泊酚联合瑞芬太尼麻醉)。比较两组麻醉前(T1)、麻醉后(T2)、术中5 min(T3)、术中20 min(T4)、术毕时(T5)平均动脉压(MAP)、心率(HR)、脉搏血氧饱和度(SpO2),同时比较两组术者对麻醉满意度、围手术期不良反应情况、手术用时、苏醒时间及转出麻醉复苏室(PACU)时间。结果瑞芬太尼组T2~T4时MAP、HR均低于麻醉前[MAP:(72.83±8.25)、(74.18±8.57)、(74.49±9.13)mmHg(1 mmHg=0.133 kPa)比(76.26±9.51)mmHg;HR:(83.21±6.63)、(85.18±7.06)、(86.81±7.53)次/min比(89.72±7.46)次/min],差异有统计学意义(P<0.05),氯胺酮组T2~T5时MAP、HR均高于麻醉前[MAP:(81.67±9.31)、(85.06±11.25)、(86.34±11.56)、(87.51±9.30)mmHg比(77.58±10.22)mmHg;HR:(95.04±9.78)、(97.60±8.24)、(98.64±10.47)、(100.21±8.56)次/min比(88.53±9.15)次/min],差异有统计学意义(P<0.05),两组T2~T5时SpO2和T1比较差异无统计学意义(P>0.05),瑞芬太尼组T2~T5时MAP、HR均低于氯胺酮组[MAP:(72.83±8.25)mmHg比(81.67±9.31)mmHg、(74.18±8.57)mmHg比(85.06±11.25)mmHg、(74.49±9.13)mmHg比(86.34±11.56)mmHg、(75.38±8.96)mmHg比(87.51±9.30)mmHg;HR:(83.21±6.63)次/min比(95.04±9.78)次/min、(85.18±7.06)次/min比(97.60±8.24)次/min、(86.81±7.53)次/min比(98.64±10.47)次/min、(88.45±9.51)次/min比(100.21±8.56)次/min],差异有统计学意义(P<0.05),两组T2~T5 SpO2和氯胺酮组比较差异无统计学意义(P>0.05);瑞芬太尼组术者对麻醉满意度高于氯胺酮组[82.35%(28/34)比58.82%(20/34)],围手术期不良反应发生率低于氯胺酮组[11.76%(4/34)比32.35%(11/34)];瑞芬太尼组手术用时、苏醒时间、转出PACU时间均短于氯胺酮组[(48.26±9.54)min比(56.32±11.86)
Objective To explore the application effect of ketamine and remifentanil in pediatric ophthalmic laryngeal mask placement general anesthesia surgery.Methods A total of 68 children who underwent ophthalmic laryngeal mask placement general anesthesia surgery in Zhangjiakou Fourth Hospital from July 2020 to May 2023 were prospectively selected and they were randomly separated into a ketamine group(34 cases,anesthesia with ketamine combined with propofol)and a remifentanil group(34 cases,propofol combined with remifentanil).The mean arterial pressure(MAP),heart rate(HR),and blood oxygen saturation(SpO 2)of the two groups were compared at before anesthesia(T 1),after anesthesia(T 2),intraoperative 5 min(T 3),intraoperative 20 min(T 4)and after surgery(T 5).Meantime,the satisfaction with anesthesia among the surgeons,perioperative adverse reactions,surgical duration,recovery time and time to transfer out of the postanesthesia care unit(PACU)were compared between the two groups.Results The MAP and HR of the remifentanil group at T 2 to T 4 were lower than before anesthesia,MAP:(72.83±8.25),(74.18±8.57)and(74.49±9.13)mmHg(1 mmHg=0.133 kPa)vs.(76.26±9.51)mmHg;HR:(83.21±6.63),(85.18±7.06)and(86.81±7.53)times/min vs.(89.72±7.46)times/min(P<0.05),while the MAP and HR of the ketamine group at T 2 to T 5 were higher than before anesthesia,MAP:(81.67±9.31),(85.06±11.25),(86.34±11.56)and(87.51±9.30)mmHg vs.(77.58±10.22)mmHg;HR:(95.04±9.78),(97.60±8.24),(98.64±10.47)and(100.21±8.56)times/min vs.(88.53±9.15)times/min(P<0.05),there was no difference in SpO 2 in the two groups between T 2 to T 5 and T 1(P>0.05),while the MAP and HR of the remifentanil group were lower than those of the ketamine group at T 2 to T 5,MAP:(72.83±8.25)mmHg vs.(81.67±9.31)mmHg,(74.18±8.57)mmHg vs.(85.06±11.25)mmHg,(74.49±9.13)mmHg vs.(86.34±11.56)mmHg,(75.38±8.96)mmHg vs.(87.51±9.30)mmHg;HR:(83.21±6.63)times/min vs.(95.04±9.78)times/min,(85.18±7.06)times/min vs.(97.60±8.24)times/min,(86.81±7.53)times/min vs.(98.64±10.47)tim
作者
张晓敏
李晓燕
高晓茹
Zhang Xiaomin;Li Xiaoyan;Gao Xiaoru(Surgical Anesthesiology Department,Zhangjiakou Fourth Hospital,Zhangjiakou 075000,China)
出处
《中国医师进修杂志》
2024年第9期823-828,共6页
Chinese Journal of Postgraduates of Medicine
基金
张家口市重点研发计划项目(2221147D)。
关键词
氯胺酮
瑞芬太尼
小儿眼科手术
全身麻醉
丙泊酚
Ketamine
Remifentanil
Pediatric ophthalmic surgery
General anesthesia
Propofol