右美托咪定与丙泊酚复合氯胺酮用于视网膜母细胞瘤患儿经股动脉穿刺行局部化疗的麻醉效果比较

发布时间：2018-02-01 12:54

本文关键词： 右美托咪啶丙泊酚氯胺酮小儿视网膜母细胞瘤化疗　出处：《武警医学》2016年11期 　论文类型：期刊论文

【摘要】：目的评价右美托咪定与丙泊酚单独复合或联合复合氯胺酮用于视网膜母细胞瘤(retinoblastoma,RB)患儿经股动脉穿刺行眼动脉局部化疗的麻醉效果,比较几种用药方法的安全性与可行性。方法择期经股动脉穿刺行眼动脉局部化疗的RB患儿60例,随机分为3组(n=20):D组、P组和DP组。所有患儿入室后静脉注射阿托品0.02 mg/kg和氯胺酮2.0mg/kg麻醉诱导,同时D组给予右美托咪定1.0μg/(kg·h),P组给予丙泊酚10 mg/(kg·h),DP组给予右美托咪定0.5μg/(kg·h)复合丙泊酚5 mg/(kg·h),分别泵注维持至术毕。记录患儿入室(T_0)、手术开始即刻(T_1)、手术后10 min(T_2)、化疗药注射即刻(T_3)、术毕即刻(T_4)、苏醒即刻(T_5)各时间点患儿BIS、NBP、HR、RR和SpO_2,记录各组患儿氯胺酮总用量和阿托品追加次数、手术时间、苏醒时间、呼吸抑制和术后躁动等不良反应的发生情况。结果与T_0比较,三组患儿在T_2,3,4时BIS值降低(P0.05),P组T_3,4时NBP降低(P0.05)。三组HR、RR和SpO_2各时间点差异无统计学意义。与D组比较,P组和DP组氯胺酮总用量减少(P0.05),追加次数减少(P0.01)。P组呼吸抑制率明显高于D组与DP组(P0.01)。三组手术时间、苏醒时间及阿托品使用率比较差异无统计学意义。所有患儿均未发生苏醒期躁动。结论在RB患儿经股动脉行眼动脉局部化疗的手术中,采用氯胺酮诱导,继以右美托咪定0.5μg/(kg·h)与丙泊酚5 mg/(kg·h)联合泵注维持可产生良好的镇静镇痛效果,且不良反应发生率低,是较适宜的麻醉组合。
[Abstract]:Objective to evaluate the effect of dexmetomidine and propofol alone or combined with ketamine on retinoblastoma of retinoblastoma. The anesthetic effect of ophthalmic artery local chemotherapy through femoral artery puncture was compared and the safety and feasibility of several methods were compared. Methods 60 cases of RB patients who underwent ophthalmic artery local chemotherapy via femoral artery puncture were selected. They were randomly divided into 3 groups: group P and group DP. All the children were anesthetized by intravenous injection of atropine 0.02 mg/kg and ketamine 2.0 mg / kg. At the same time, group D was given propofol (10 mg/(kg 路h). In the DP group, dexmetomidine 0.5 渭 g / kg 路h) combined with propofol 5 mg/(kg 路hU was administered to the patients until the end of operation. Immediately after operation, T1 was given, and 10 minutes after operation, the patients were treated with BIS. The patients had BIS at each time point after the injection of chemotherapeutic drugs, and immediately after the operation, and immediately after the operation, and immediately after the operation, the patients were treated with T _ 4, and the patients were treated with T _ (5) at each time point after the operation. The total dosage of ketamine, the times of addition of atropine, the time of operation and the time of recovery were recorded. Results compared with TCI, the BIS of the three groups was lower than that of the control group (P 0.05 and P < 0.05), and the BIS value of the three groups was lower than that of the control group (P 0.05 and P < 0.05). 4:00 NBP decreased P0.05. There was no significant difference in HRRR and SpO_2 between the three groups. Compared with group D, the total dosage of ketamine in P group and DP group was decreased (P 0.05). The rate of respiratory inhibition in group P was significantly higher than that in group D and group DP. There was no significant difference in recovery time and atropine usage rate. No restlessness occurred in all children. Conclusion ketamine is used to induce local chemotherapy of ophthalmic artery in RB patients. The combination of dexmetomidine (0.5 渭 g / kg 路h) and propofol (5 mg/(kg 路h) could produce good sedative and analgesic effects, and the incidence of adverse reactions was low. It is a more suitable combination of anesthesia.
【作者单位】：武警总医院麻醉科;
【分类号】：R614;R739.7
【正文快照】： 视网膜母细胞瘤(retinoblastoma,RB)是一种常见的先天性肿瘤,其全身化疗的不良反应较大、针对性不强。近年来,经股动脉穿刺行眼动脉局部化疗的技术开展渐渐增多,其操作精细,需要绝对制动,但因小儿一般不能耐受股动脉穿刺时的疼痛以及离开家长后的恐慌,不能安静地配合手术,常需

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