曲马多丙泊酚复合骶管阻滞在小儿下腹部手术的临床观察(1)
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【摘要】 目的 探讨曲马多丙泊酚复合骶管阻滞用于小儿下腹部手术的临床效果和安全性。方法 60例患儿随机分成2组, 曲马多丙泊酚复合骶管阻滞组(Ⅰ组,n=30)和氯胺酮丙泊酚复合骶管阻滞组(Ⅱ组,n=30),I组应用曲马多丙泊酚复合骶管阻滞,Ⅱ组应用氯胺酮丙泊酚复合骶管阻滞。于麻醉前、切皮、术中、术毕记录其血压、心率、呼吸频率、血氧饱和度,并比较2组苏醒时间以及苏醒时躁动。结果 术中血压、心率、呼吸频率，Ⅱ组高于Ⅰ组，差异有统计学意义(P<0.05)；Ⅰ组苏醒时间明显短于Ⅱ组，Ⅰ组苏醒时躁动明显少于Ⅱ组，差异有统计学意义(P<0.01)。结论 曲马多丙泊酚复合骶管阻滞用于小儿腹部以下手术,呼吸、循环稳定,麻醉满意,术后恢复快,是一种较为理想的麻醉方法。
【关键词】
曲马多；丙泊酚；骶管阻滞;下腹部手术
Application of tramadol propofol combined with sacral block in blow belly surgery in children
LI Hong-xi.Zhangzhou Municipal Hospital,Zhangzhou 363000,China
【Abstract】 Objective
It is to approach the efficacy and safety of tramadol propofol combined with sacral block in blow belly surgery in children.Methods Sixty patients with blow belly disease were randomly divided into two groups:tramadol propofol combined with sacral block group(groupⅠ,n=30) and ketamine propofol combined with sacral block group (groupⅡ,n=30). Patients In groupⅠwere received tramadol propofol combined with sacral block anesthesia. Patients In groupⅡwere received ketamine propofol combined with sacral block anesthesia. The blood pressure, heartrate, andrespiratory rate were recorded before, during and after anesthesia. the recovery time and restlessness during the time of palinesthesiwas comparedbetween two groups.Results Blood pressure,heart rate and respiratory rate were higher in groupⅡthan those in groupⅠ(P<0.05). The recovery time was significantly longer in groupⅡthan that in groupⅠ, restlessness during the time of palinesthesi more in groupⅡthan that in groupⅠ (P<0.01).Conclusion Tramadol propofol combined with sacral block can be used as a safe anesthetic in blow belly surgery in children.
【Key words】
Tramadol；Propofol；Sacral block；Blow belly surgery
作者单位：363000漳州市医院
骶管麻醉用于小儿下腹部手术具有止痛完善，肌松满意，并发症相对少的优点，然而小儿不宜合作的特点，在骶管麻醉操作过程前及手术中常需辅助静脉麻醉药。传统小儿麻醉药辅助药为氯胺酮，有学者报道,氯胺酮有高血压反应和肢体肌肉不自主运动和术后精神症状，复合安定等药物可减少氯胺酮用量,减轻氯胺酮的不良反应[1],但仍有高并发症及药物副作用出现,对围术期呼吸循环等方面的管理有较大的困难。为了降低其不良反应的发生，本文探讨用曲马多替代氯胺酮用于小儿下腹部手术可能性，曲马多具有镇痛作用,对呼吸抑制作用比较弱,在正常情况下缓慢静推复合丙泊酚有良好的镇痛镇静作用。丙泊酚是一种速效静脉全麻药,具有起效快而平稳,苏醒快且脑功能恢复完善,术后恶心呕吐发生率低等优点,由于丙泊酚本身镇痛作用弱,故术中还需辅助镇痛药或局部麻醉,以减少其用量和副作用的发生,使麻醉更平稳安全。我科从2009年开始,使用曲马多丙泊酚复合骶管阻滞用于小儿下腹部手术,取得满意麻醉效果,现报告如下。
1 资料与方法
1.1 一般资料
选择择期下腹部手术患儿60例,ASAⅠ级,男38例,女22例,年龄6月至6岁,体重6~23 kg,腹股沟斜疝修补术43例、隐睾睾丸固定术11例、阑尾切除术4例、其他2例 ......
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