微创医学

目的对比观察丙泊酚复合氯胺酮和单纯丙泊酚或氯胺酮静脉麻醉在先心病患儿封堵术中应用的临床效果。方法选择先心病患儿90例，随机分为三组，每组30例，PK组：丙泊酚复合氯胺酮静脉麻醉；P组：丙泊酚静脉麻醉；K组：氯胺酮静脉麻醉。观察记录手术期间三组患儿术前、股动静脉穿刺时、放置封堵器时的MAP、HR、SpO2、RR、苏醒时间、不良反应、麻醉药用量。结果PK组手术期间MAP、HR变化无统计学意义，P组手术期间MAP、HR明显下降；K组手术期间MAP、HR明显升高，与术前相比差异均有统计学意义（P〈0．05），三组患儿术中SpO2〉93％，三组比较差异无统计学意义（P〉0．05）；苏醒时间：PK组与P组比较差异无统计学意义，但K组明显长于PK组和P组，差异有统计学意义（P〈0．01）；P组丙泊酚用量明显大于PK组，K组氯胺酮用量也明显大于PK组，差异均有统计学意义（P〈0．05）。结论丙泊酚复合氯胺酮静脉麻醉在先心病患儿介入治疗中应用麻醉效果好，可控性强，不良反应少，麻醉过程更趋平稳，明显优于单纯丙泊酚静脉麻醉或单纯氯胺酮静脉麻醉

Objective To compare the effects of propofol-ketamine combination intravenous anesthesia with propofol or ketamine separately in transcatherer closure of congenital heart disease of children. Methods 90 childrens with congenital heart disease for transeatherer closure were randomly divided in to 3 groups ： group PK （ propofol-ketamine combination, n = 30） , group P （ propofol, n = 30） and group K （ ketamine, n = 30）. The changes of MAP, HR, SpO2 and RR before operation, at time of femoral vein and artery puncture and transcather closure placement,wake-up time, side effects, dosage of narcotic were recorded respectively for the three groups. Results MAP and HR during operation were lower in group PK, and higher in group K,but remained statistically unchanged in group PK. SpO2 were more than 93% in 3 groups,and without significant difference among them. As for the wake-up time ,there was no significant difference between group PK and group K, but it was much longer in group K than in group PK and group P. The dosage of ketamine of group K or group P was more than that of group PK（ P 〈 0.05 ）. Conclusion Propofol-ketamine combination intravenous anesthesia is effective,controllable and stable with less side effect, being superior to propofol or ketamine separately in transcatherer closure of congenital heart disease of children.