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【摘要】 目的 观察利用周围神经刺激器辅助定位,罗比卡因臂丛神经阻滞复合氯胺酮静脉麻醉在小儿上肢手术中应用,对呼吸循环功能以及术后恢复情况的影响。方法 30 例行上肢手术患儿随机分为两组:臂丛神经阻滞复合氯胺酮静脉麻醉组(A组),氯胺酮基础麻醉后,应用神经刺激器辅助定位臂丛阻滞成功后注入0.25%罗比卡因0.5 ml/kg;单纯氯胺酮静脉麻醉组(B组),术中氯胺酮 1~2 mg/(kg•h)间断静脉注射。结果 术中 A组循环、呼吸功能较B组稳定;肢体不良自主运动,喉痉挛等不良反应较B组少,A组氯胺酮用量明显少于B组;术后A组苏醒较快且平稳,恢复期精神症状少,与B组比有显著差异。结论 臂丛神经阻滞复合氯胺酮静脉麻醉应用于小儿上肢手术,可减少氯胺酮用量从而减少其不良反应,使患儿在麻醉手术期间呼吸循环更平稳,家长及医护人员满意度明显提高。
【关键词】臂丛神经阻滞;氯胺酮;静脉麻醉;手术
Brachial plexus block combined with ketamine intravenous anesthesia in pediatric surgery of upper extremity
XUE Minqiang.Hancheng Mining Bureau General Hospital Shanxi,hancheng 715400,China
【Abstract】 Objective To observe the use of peripheral nerve stimulatorassisted positioning,ropivacaine brachial plexus block combined with ketamine intravenous anesthesia in pediatric upper extremity surgery applications,pairs of respiratory and circulatory functions and postoperative recovery situation.Methods 30 routine upper extremity surgery were randomly divided into two groups:brachial plexus block combined with ketamine intravenous anesthesia group(A group),ketaminebased anesthesia,application of nerve stimulatorassisted positioning brachial plexus block injected 0.25% after the success of Romania than Cain 0.5 ml/kg; pure ketamine intravenous anesthesia group(B group),intraoperative ketamine 1~2 mg/(kg•h)intermittent intravenous injection.Results A group of cycles in the results of surgery,respiratory function compared with B group stability; body negative selfmovement,laryngeal spasm fewer adverse reactions than the B group,A group of ketamine dosage was less than B; after A group of awake faster and stable recovery period of fewer psychiatric symptoms,compared with the B group were significantly different.Conclusion brachial plexus block combined with ketamine intravenous anesthesia for pediatric upper extremity surgery,can reduce the dosage of ketamine to reduce their adverse reactions to anesthesia in children with more stable during the respiratory and circulatory,parents and staff satisfaction has improved significantly.
【Key words】Brachial plexus block;Ketamine;Intravenous anesthesia;Surgery
小儿上肢手术传统上常采用氯胺酮复合咪唑安定静脉麻醉方法,臂丛神经阻滞用于小儿上肢手术,麻醉操作简单、安全有效,但由于小儿多不合作术中常需要给予一定的镇痛、镇静药。本院采用臂丛神经阻滞复合氯胺酮微泵输注麻醉取得了满意的效果。
1 资料与方法
1.1 一般资料 选择行上肢手术的患儿30例,ASAⅠ~Ⅱ级,年龄4~11岁,其中男20例,女10例,体质量14~25 kg。按麻醉方法不同,将患儿随机分为臂丛神经阻滞复合氯胺酮静脉麻醉组(A组)和单纯氯胺酮静脉麻醉组(B组)。两组患儿年龄、性别、体质量、手术时间比较无显著性差异。
1.2 麻醉与用药 两组患儿术前30 min肌内注射东莨菪碱0.01 mg/kg。入室前氯胺酮5 mg/kg,达咪唑仑0.1 mg/kg肌内注射,开放静脉通路持续鼻导管给氧,常规监测血压BP、心率HR、心电图EKG、脉搏血氧饱和度SpO2。A组用刺激电极复合针,将神经刺激器电流调为0.1 mA、频率1 Hz、脉宽0.1 ms,当探及所欲阻滞区域的肌肉收缩时,减小刺激电流道0.3~0.5 mA,仍有肌肉颤搐则说明定位正确,注入局麻醉药2 ml,肌颤消失,回抽无回血,则注入余下的局麻醉药局麻药用0.25%罗比卡因0.5 ml/kg不含肾上腺素术中患儿有明显肢动,则按需静脉追加氯胺酮。B组术中间断静脉推注氯胺酮1~2 mg/kg维持麻醉。
1.3 观察指标 术中持续监测BP、HR、SpO2的变化,记录术前、切皮、术中最大刺激时、缝皮时上述各指标的情况,术中氯胺酮药用量及不良反应情况,麻醉恢复过程中记录苏醒时间及程度,术后镇痛时间。
2 结果
2.1 血液动力学情况 A组术中BP、HR较平稳,与术前比波动小,而B组较术前高且波动较大,两组间比较有显著性差异。
2.2 术中情况 术中A组有 1 例出现肢体不自主运动,而B组则有7 例;A组有1 例发生喉痉挛,而B组有1 例出现呕吐,4例发生喉痉挛;A组出现不良反应明显少于B组。
2.3 氯胺酮用量及术后恢复情况 术中 A组氯胺酮药用量明显少于B组;术后镇痛时间 A组明显长于B组P
