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目的探讨小剂量芬太尼、右美托咪定和氯胺酮用于预防小儿七氟烷麻醉术后躁动对呼吸循环系统功能和术后恢复质量的影响。方法选择美国麻醉医师协会(ASA)麻醉风险Ⅰ~Ⅱ级,拟择期于全麻下行斜视手术的患儿,随机分成对照组(Ⅰ)、芬太尼(ⅡF)、右美托咪定(ⅡD)和氯胺酮(ⅡK组)3个观察组。所有患儿均吸入8%七氟烷诱导并置入喉罩;3%七氟烷维持麻醉,保留自主呼吸。3个观察组在手术开始前分别给予芬太尼1μg/kg(ⅡF)、右美托咪定0.5μg/kg(ⅡD)和氯胺酮0.5 mg/kg(ⅡK),I组则给予生理盐水10 ml。记录静脉给予药物或生理盐水前(0 min)、给药后5、10、15、20 min时的脉搏血氧饱和度(Sp O2)、潮气量(VT)、呼吸频率、呼气末二氧化碳分压(PET-CO2)。停药30 min后记录患儿躁动评分和恶心呕吐发生率。记录患儿在术后恢复室停留时间。结果 120例患儿纳入本研究,每组30例。ⅡF组患儿躁动发生率20.0%,ⅡD组13.3%,ⅡK组10.0%,均显著低于Ⅰ组发生率(46.7%,P均<0.05)。恢复室停留时间依次为,ⅡK组(37.5±18.4)min,ⅡD组(35.6±16.1)min,ⅡF组(31.1±16.2)min,Ⅰ组(29.4±14.6)min,其中ⅡK组和ⅡD组明显长于ⅡF组和Ⅰ组(P<0.05)。ⅡF组患儿的呼吸频率和分钟通气量在给药后5 min开始减慢,20 min时恢复至给药前水平。结论 1μg/kg芬太尼、0.5μg/kg右美托咪定和0.5 mg/kg氯胺酮均可安全用于小儿七氟烷麻醉,降低躁动的发生率,提高恢复期质量。芬太尼更适合在短小手术中使用。
Objective To investigate the effects of low-dose fentanyl, dexmedetomidine and ketamine on respiratory system function and postoperative recovery after pediatric sevoflurane anesthesia. Methods Anesthesia risk Ⅰ ~ Ⅱ of American Society of Anesthesiologists (ASA) were randomly divided into control group (Ⅰ), fentanyl (ⅡF) and dexmedetomidine (ⅡD ) And ketamine (Ⅱ K group) three observation groups. All children were induced by inhalation of 8% sevoflurane and laryngeal mask; 3% sevoflurane to maintain anesthesia, to maintain spontaneous breathing. Three observation groups were given fentanyl 1μg / kg (ⅡF), dexmedetomidine 0.5μg / kg (ⅡD) and ketamine 0.5 mg / kg (ⅡK) respectively before the operation. Group I was given saline 10ml . The pulse oxygen saturation (Sp O2), tidal volume (VT), respiratory rate, end-tidal carbon dioxide score at 5, 10, 15 and 20 min after administration of drug or saline were recorded Pressure (PET-CO2). After stopping the medicine for 30 minutes, the incidence of agitation and nausea and vomiting were recorded. Record children in the recovery room after the stay. Results 120 cases of children were included in this study, 30 cases in each group. The incidence of agitation in group ⅡF was 20.0%, in group ⅡD 13.3% and in group ⅡK 10.0%, both of which were significantly lower than those in group Ⅰ (46.7%, P <0.05). The length of stay in the recovery room were: ⅡK group (37.5 ± 18.4) min, ⅡD group (35.6 ± 16.1) min, ⅡF group (31.1 ± 16.2) min, Ⅰ group (29.4 ± 14.6) min, ⅡK group and ⅡD group Longer than Ⅱ F group and Ⅰ group (P <0.05). The respiratory rate and minute ventilation in group ⅡF began to decrease at 5 min after administration and returned to pre-administration level at 20 min. Conclusions 1μg / kg fentanyl, 0.5μg / kg dexmedetomidine and 0.5mg / kg ketamine can be safely used in pediatric sevoflurane anesthesia, reduce the incidence of agitation and improve the recovery quality. Fentanyl is more suitable for use in short surgeries.