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目的探讨小剂量氯胺酮联合低血浆靶浓度瑞芬太尼用于小儿全麻的效果观察。方法选取海口市妇幼保健院2012年4月至2013年12月收治的74例腹股沟斜疝择期手术患儿作为研究对象,采用随机数字表法分为对照组(n=37)和观察组(n=37)。对照组给予氯胺酮联合咪唑安定全麻,观察组给予靶控输注小剂量氯胺酮联合瑞芬太尼全麻,比较两组患儿麻醉情况。结果对照组插管后心率(HR)、平均动脉压(MAP)、脑电双频指数(BIS)、听觉诱发电位指数(AEPI)指标显著高于插管前,差异有统计学意义(P<0.05);对照组手术结束时BIS、AEPI指标显著低于麻醉前,差异有统计学意义(P<0.05);观察组手术结束时HR、MAP、BIS、AEPI指标显著低于麻醉前,差异有统计学意义(P<0.05);观察组氯胺酮用量、苏醒时间、术中体动及苏醒期躁动发生率均显著低于对照组,且差异有统计学意义(P<0.05)。结论小儿全麻采用小剂量氯胺酮联合低血浆靶浓度瑞芬太尼,能降低氯胺酮用量,保持血液动力学稳定,麻醉效果良好。
Objective To investigate the effect of low dose ketamine combined with low plasma target concentration of remifentanil on general anesthesia in children. Methods Seventy-four children undergoing elective inguinal hernia surgery from April 2012 to December 2013 in Haikou MCH hospital were selected as study subjects, and randomly divided into control group (n = 37) and observation group (n = 37) = 37). The control group was given ketamine combined with midazolam general anesthesia. The observation group was given target-controlled infusion of low-dose ketamine combined with remifentanil general anesthesia. The anesthesia in both groups was compared. Results The HR, MAP, BIS and AEPI in control group were significantly higher than those before intubation (P < 0.05). The indexes of BIS and AEPI in the control group at the end of surgery were significantly lower than those before anesthesia (P <0.05). The indexes of HR, MAP, BIS and AEPI in the observation group were significantly lower than those before anesthesia (P <0.05). The dosage of ketamine, recovery time, intraoperative physical activity and wakefulness agitation rate in the observation group were significantly lower than those in the control group, and the difference was statistically significant (P <0.05). Conclusion Pediatric general anesthesia with low-dose ketamine combined with low plasma target concentration remifentanil can reduce ketamine dosage, maintain hemodynamic stability, and good anesthetic effect.