【摘要】 目的探讨罗哌卡因骶管阻滞辅以氯胺酮用于小儿经肛门先天性巨结肠I期根治术的麻醉效果及对患儿应激反应的影响。方法48例先天性巨结肠根治术随机分为两组,A组:罗哌卡因骶管阻滞辅以氯胺酮;B组:用羟丁酸钠慢诱导气管插管辅以氯胺酮和维库溴胺。观察麻醉效果,连续监测HR、RR、SpO₂、ECG、有创血压,并分别于基础麻醉后（T₀）、手术开始5分钟（T₁）、1小时（T₂）、2小时（T₃）、术毕（T₄）抽取左侧挠动脉血测定血气、血糖和血浆皮质醇含量。结果A、B两组循环、呼吸均平稳,A组血糖各时点与基础值T₀无明显差异,而明显低于B组各时点（P<0.05）,A组皮质醇T₂ T₃高于T₀、T₁和T₄（P<0.05）,而明显低于B组各时点（P<0.05）。结论 罗哌卡因骶管阻滞辅以氯胺酮用于经肛门先天性巨结肠I期根治术是比较适宜的麻醉方法,并能较好抑制患儿应激反应。更多还原

【Abstract】 Objective To discuss the anesthesia effectiveness and influence of sacral canal blocking by ropivacain with assisting ketamine in a new operative treatment of children with phase I Hirschsprung’s disease. Methods 24 patients with Hirschsprung’s disease were randomly divided into the two groups. Group A:sacral canal blocking by ropivocaine with assisting ketamine: Group B: tracheal cannula slowly induced by sodium droxybutytate with assisting ketamine and vecuronium. HR, RR, SpO2, ECG and invasive BP were persistent monitored. Blood gas, blood sugar and content of hydrocortisone in serum were determined at the time point of just anesthesia (T0), 5 minutes after starting operation(T1), 1 hour(T2), 2 hours(T3), operation compeleted(T4). Results Circulation and respiration were stable at two groups, there was no seriously diferrence of blood sugar at group A at each moment, but seriously lower than the same moment at group B(p<0.05). Hydrocortisone in serum at group A at T2, T3 was higher than at T0, T1 and T4 (p<0.05), but obviously lower than the same moment at group B(p<0.05). Conclusions Using sacral canal blocking by ropivacaine with assisting ketamine is not only a kind of suitable anesthesia method for a new radical operation of phase I Hirschsprung’s disease, but also can suppress the stress reaction of children.更多还原