氯胺酮复合咪达唑仑全麻在无水乙醇治疗先天性周围血管畸形中的效果评价

目的:观察氯胺酮复合咪达唑仑在无水乙醇治疗儿童先天性周围血管畸形的应用效果。方法:选择择期全麻下行无水乙醇治疗周围血管畸形儿童50例,随机分为两组:氯胺酮复合咪达唑仑组(M组)和丙泊酚持续输注组(P组),M组以咪达唑仑和氯胺酮基础下全麻,P组采用芬太尼镇痛基础下丙泊酚持续静注全麻,观察并记录入室(T_0)、麻醉诱导后5 min(T_1)、手术开始后30、60、90 min(分别为T_2、T_3、T_4)、拔管后5 min(T_5)的MAP与HR,监测脑电双频指数(bispectral index,BIS)并记录BIS40次数、平均注射无水乙醇量、术中输液量、苏醒时间及苏醒后5 min视觉模拟评分(Visual analog scales,VAS)、Ramsay镇静评分结果。结果:(1)与M组相比,P组MAP(T_2～T_54个时间点)、HR(T_1～T_55个时间点)和BIS值(T_3和T_42个时间点)均显著降低,差异有统计学意义(P0.05);三个指标其余时间点两组患儿相比,差异均无统计学意义(P0.05);(2)与M组患儿相比,P组BIS值40的患儿例数以及应用阿托品和麻黄碱例数均显著增加,差异具有统计学差异(P0.05);两组患儿平均无水乙醇注射量比较显著差异无统计学意义(P0.05);(3)与M组相比,P组患儿全麻苏醒拔管后5 min VAS评分显著降低,Ramsay评分显著升高(P0.05);两组患儿不良事件发生率均无统计学差异(P0.05)。结论:氯胺酮复合咪达唑仑下全麻应用于无水乙醇注射治疗儿童周围血管畸形,能维持术中血流动力学平稳,且缩短苏醒时间。

The Effect of Ketamine Combined with Midazolam in the Treatment of Vascular Malformations with Ethanol Under General Anesthesia

ABSTRACT Objective: To evaluate the effect of ketamine combined with midazolam for ethanol treatment in congenital vascular malformations under general anesthesia. Methods: Fifty pediatric patients scheduled for ethanol treatment in congenital vascular malformations under general anesthesia were randomly divided into ketamine combined with midazolam group (M group) and propofol group (P group), with 25 cases in each group. Children in group M was treated with midazolam and ketamine, and group P with continuous infusion of propofol on the basis of sufentanil. During the procedure, MAP and HR were recorded at baseline (T0), 5 min after induction (T1), 30, 60, 90min (T2, T3, T4) after beginning of the operation, and 5 min after extubation (T5). BIS index and the number of BIS<40, the average ethanol consumption, operation time, infusion volume, recover time, VAS and Ramsay score after extubation were recorded. Results: (1) Compared with the M group, the MAP (T2 ~ T5 4 time points), HR (T1 ~ T5 5 time points) and BIS values (T3 and T4 2 time points) of P group were significantly reduced(P<0.05). there were no significant difference in the three indicators between the two groups (P>0.05). (2) Compared with the group M, the cases of children with BIS value <40 and with atropine and ephedrine in group P were both increased significantly, the difference was statistically significant (P<0.05). There was no significant difference in the amount of absolute ethanol injection (P>0.05). (3) Compared with the M group, the VAS score was significantly lower at 5 min after general anesthesia in the P group, and the Ramsay score was significantly increased (P<0.05). There was no significant difference in adverse event rate between the two groups (P>0.05). Conclusion: Midazolam combined with ketamine in the treatment of congenital vascular malformation with ethanol could stabilize hemodynamic parameters in the operation and shorten the awakening time in pediatric patients.