姚建武　肖　庆

【摘要】 目的 对比观察硬膜外阻滞复合丙泊酚或氯胺酮麻醉用于小儿下腹部手术的临床效果。方法 40例择期下腹部手术的患儿ASA评级I~II级，随机分为两组，第I组为硬膜外加丙泊酚组，第II组为硬膜外加氯胺酮。观察麻醉围手术期收缩压(SBP)、舒张压（DBP）、心率（HR）、脉搏氧饱和度（SpO₂）、呼吸（RR）的变化。结果 两组比较，术中麻醉效果满意，围术期呼吸循环稳定，第I组其临床效果优于第II组。结论 硬膜外阻滞复合丙泊酚用于小儿下腹部手术应激反应小、不良反应少，全身麻醉用药量小，患儿恢复快。

【关键词】硬膜外阻滞；丙泊酚；氯胺酮；下腹部手术

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Applying epidural blockade combining with Propofol or ketamine to hypogastric operation of children

YAO Jian-wu，XIAO Qing.Department of Anesthesiology, the First Hospital of Liangshanzhou,Sichuan 615000,China

【Abstract】 Objective To contrast the effect of applying epidural blockade combined with Propofol or ketamine to hypogastric operation of children.Methods 40 children needed hypogastric operation were divided into two groups randomly, the grade of them according to ASA was I-II.The first group was epidural blockade combined with Propofol, and the other group was epidural blockade combined with ketamine.Observe the perioperative variation of blood pressure, heart rate, pulse oximetry, respiration.Results Contrast the effect of two group, there was satisfied aesthetic outcome and steady respiratory circulation failure.Besides this, the aesthetic better than that of the second group.Conclusion Applying epidural blockade combining with Propofol to hypogastric operation of children, there is little adverse reaction and dosage.

【Key words】Epidural blockade;Propofol;Ketamine;Hypogastric operation

小儿下腹部手术要求止痛完善，肌松满意，硬膜外麻醉即可达到以上效果，尽管麻醉效果很好，由于患儿恐惧，多数不易合作，常需辅助镇静药或全麻药。本文选择小儿硬膜外阻滞复合丙泊酚、氯胺酮麻醉的临床应用，主要观察围术期对循环功能的影响。

1 资料与方法

1．1 一般资料 ASA I~II级，患儿智力正常，无肝、肾疾病，无药物过敏史。5~11岁择期下腹部手术40例，其中斜疝修补手术24例、阑尾切除手术16例。男27例，女13例，手术时间30~68 min。随机分为二组：第I组为硬膜外加丙泊酚组（n=20），第II组为硬膜外加氯胺酮（n=20）。两组病例均无任何麻醉并发症，恢复良好出院。

1．2 麻醉方法 常规禁饮禁食，术前30 min肌内注射阿托品0．01 mg/kg，苯巴比妥钠3 mg/kg。入室前、后给予心理安慰，接惠普监护仪，监测心电、血压、心率、血氧饱和度，面罩给氧3 L/min，开放静脉通道，患儿取侧卧位，于L2~3或L_3~4间隙穿刺，向上置管2~3 cm，穿刺成功确认无误后将患儿置于平卧位，用1%利多卡因+0．25%布比卡因混合液3 ml做试探量，5 min后测平面，无全脊麻征，根据麻醉平面推5~8 ml，平面控制在T₆以下。……