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目的观察臂丛神经阻滞复合氯胺酮麻醉在小儿上肢手术中的应用效果。方法选择单侧上肢骨折行切开内固定手术的患儿60例,随机分为治疗组30例和对照组30例:治疗组患儿采用臂丛神经阻滞麻醉,术中给予氯胺酮强化;对照组采用氯胺酮复合咪唑安定全身麻醉。观察手术中HR、SpO2、MAP的变化;观察麻醉期间氯胺酮的用量及术毕神志恢复情况。结果治疗组患儿术后立即清醒,术后1小时哭闹和术后2小时哭闹的人数均多于对照组的患儿,(P<0.05)。治疗组氯胺酮总用量明显小于对照组(P<0.05);治疗组HR及MAP增高,SpO2下降的人数明显小于对照组(P<0.05)。结论臂丛神经阻滞复合氯胺酮麻醉效果完善,安全系数高,全麻药用量小,是小儿上肢手术较为理想的麻醉方法。
Objective To observe the effect of brachial plexus block and ketamine anesthesia in pediatric upper limb surgery. Methods Sixty children with unilateral upper extremity fracture undergoing internal fixation operation were randomly divided into treatment group (n = 30) and control group (n = 30). The treatment group was treated with brachial plexus block and was given ketamine intraoperatively. Group using ketamine combined midazolam and general anesthesia. The changes of HR, SpO2 and MAP during operation were observed. The dosage of ketamine and recovery of consciousness during operation were observed. Results The patients in treatment group were awake immediately after operation, crying at 1 hour after operation and crying at 2 hours after operation were more than those in control group (P <0.05). The total amount of ketamine in the treatment group was significantly lower than that in the control group (P <0.05). The HR and MAP in the treatment group were significantly higher than those in the control group (P <0.05). Conclusion The brachial plexus block combined with ketamine has a good anesthetic effect, high safety factor and small dosage of general anesthetic. It is an ideal anesthetic method for pediatric upper limb surgery.