【摘要】 目的:观察丙泊酚复合亚麻醉剂量氯胺酮用于小儿斜视矫正手术,其对血流动力学的影响和术后恢复结果。方法:40例ASAⅠ—Ⅱ级行择期小儿斜视矫正手术患者,随机分为丙泊酚复合亚麻醉剂量氯胺酮组(PK组,n=20)和氯胺酮组(K组,n=20)。分别观察麻醉前、气管插管即刻、手术开始即刻、术中第15分钟、手术结束时即刻的心率(HR)、平均动脉压(MAP)。停药后记录完全清醒时间(自动睁眼和指令性反应恢复)以及术后恶心、呕吐的情况。结果:K组插管即刻、手术开始即刻、术中第15分钟及手术结束即刻的HR、MAP与术前基础值相比均有增快和升高(P<0.05)。而PK组的上述参数与术前基础值相比则无显著变化(P>0.05)。PK组和K组的相应各时点参数间相比较均有显著差异(P<0.01)。PK组患者的清醒时间明显短于K组(P<0.01),PK组患者的恶心呕吐发生率亦明显低于K组(P<0.01)。结论:丙泊酚复合亚麻醉剂量氯胺酮用于小儿斜视矫正术可产生良好的麻醉效应,维持术中血流动力学稳定,苏醒迅速完全,术后恶心、呕吐发生率低。更多还原

【Abstract】 Objective:To investigate the effects of propofol combined with low-dose ketamine on hemodynamics in children dur ing strabismus surgery and the results of postoperative recovery.Methods:Forty ASAⅠ-Ⅱchildren scheduled for strabismus surgery were randomly allocated to one of the two groups:propofol combined with low dose ketamine group（group PK.n= 20）and ketamine group（group K.n=20）.The patients were premedicated with intramuscular midazolam 0.15mg and atro pine 0.015 mg·kg^-130min before operation.In propofol combined with low dose ketamine group anesthesia was induced with fentanyl 3 ug·kg^-1propofol 3 mg·kg^-1and vecuronium 0.08～0.1 mg·kg^-1and maintained with propofol infusion 6～10 mg·kg^-1·h^-1and ketamine infusion 0.6～1.0 mg·kg¹·h¹ after tracheaIintubation.In ketamine group anesthesia was induced with fentanyl 3 ug·kg¹,ketamine 2 mg·kg^-1and vecuronium 0.08～0.1 mg·kg¹ and maintained with ketamine infusion 2. 5～8 mg·kg¹·h^-1after trachealintubation.Mean arterial pressure（MAP）and heart rate（HR）were determined beforeanes thesia,after intubation,at skin incision.15min after operation and at the end of operation.Awake time and postoperative nau- sea vomiting were observed after operation.Results:Ingroup K MAP and HR increased significantly after intubation,at skin incision,15min after operation and at the end of operation（P<0.05）whereas there was no significant change in MAP and HR in group PK.MAP and HR were lower after intubation,at skin incision.15min after operation and at the end of operation in group PK than those in group K（P<0.01）.Awake time in group K was significantly longer than that in group PK（P<0.01）. The incidence of PONV in group PK was lower than that in group K（P<0.01 ）.Conclusion:Propofol combined with low-dose ketamine anestbesia is effective in keeping the stability of hemodynamics,making awake quikly and reducing the incidence of PONV in pediatric strabismus surgery.更多还原