文章摘要
右美托咪定复合氯胺酮用于患儿经皮肾穿刺活检术的效果
Anesthetic efficacy of dexmedetomidine combined with ketamine in pediatric patients undergoing percutaneous renal biopsy
  
DOI：10.12089/jca.2019.05.004
中文关键词: 右美托咪定  氯胺酮  患儿  经皮肾穿刺活检术
英文关键词: Dexmedetomidin  Ketamine  Childron  Percutaneous renal biopsy
基金项目:
作者单位E-mail
李强 330006,南昌市,江西省儿童医院麻醉科  
胡华琨 330006,南昌市,江西省儿童医院麻醉科  
肖煜 330006,南昌市,江西省儿童医院麻醉科  
沈世晖 330006,南昌市,江西省儿童医院麻醉科  
傅欢 330006,南昌市,江西省儿童医院麻醉科  
叶玲玲 南昌大学第一附属医院 453043316@qq.com 
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中文摘要:
      
目的 探讨右美托咪定复合氯胺酮用于患儿经皮肾穿刺活检术的效果。
方法 选择拟行经皮肾穿刺活检术的患儿60例，男32例，女28例，年龄1～12岁，体重9～36 kg，ASA Ⅱ或Ⅲ级。采用随机数字表法随机分为两组：右美托咪定复合氯胺酮组（DK组）和丙泊酚复合氯胺酮组（PK组），每组30例。入室后DK组先予右美托咪定1 μg/kg负荷量，10 min泵完，后予氯胺酮1 mg/kg静注诱导，右美托咪定0.5 μg·kg-1·h-1泵注维持；PK组缓慢静注丙泊酚中长链脂肪乳2～2.5 mg/kg、氯胺酮1 mg/kg诱导，丙泊酚中长链脂肪乳6 mg·kg-1·h-1泵注维持。术中出现体动反应时静脉追加氯胺酮0.5 mg/kg。观察并记录两组术中体动反应、氧饱和度下降（SpO2＜95%）的发生情况，记录追加氯胺酮情况、术后苏醒时间和苏醒期躁动的发生情况。
结果 DK组术中体动反应和SpO2下降发生率明显低于PK组(P＜0.05)。DK组追加氯胺酮比例明显少于PK组(P＜0.05)，苏醒时间明显长于PK组(P＜0.05)，苏醒期躁动发生率明显低于PK组(P＜0.05)。
结论 右美托咪定复合氯胺酮全麻用于患儿经皮肾穿刺活检术，可有效降低患儿术中体动反应和SpO2下降发生率，降低追加氯胺酮比例，减少苏醒期躁动，但延长了苏醒时间。
英文摘要:
      
Ojective To study the anesthetic efficacy of dexmedetomidine combined with ketamine in pediatric patients undergoing percutaneous renal biopsy.
Methods Sixty children undergoing percutaneous renal biopsy, including 32 males and 28 females, aged 1 - 12 years, weighing 9 - 36 kg, falling into ASA physical status Ⅱ or Ⅲ, were randomly divided into two groups, 30 cases in each: dexmedetomidine combined with ketamine group (group DK) and propofol combined with ketamine (group PK). Group DK received dexmedetomidine iv infusion 1 μg/kg bolus over 10 min and ketamine 1 mg/kg, followed by iv infusion of dexmedetomidine 0.5 μg·kg-1·h-1. Group PK received propofol 2 - 2.5 mg/kg and ketamine 1 mg/kg for induction followed by iv infusion of propofol 6 mg·kg-1·h-1 for maintenance. Ketamine 0.5 mg/kg was added intravenously in children when body movement occurred. The occurrence of intraoperative body movement oxygen saturation (SpO2 < 95%), the dosage of ketamine, the occurrence of postoperative recovery time and emergence agitation during recovery period were observed and recorded.
Results Compared with group PK, the incidence of body dynamic reaction and desaturation and the dosage of ketamine in group DK were significantly lower (P<0.05). In addition, the recovery time in group DK were markedly longer than that in group PK (P<0.05), while the incidence of emergence agitation, in group DK was significantly decreased (P<0.05).
Conclusion Dexmedetomidine combined with ketamine can effectively decrease body movement, alleviate hemodynamics fluctuation, economize ketamine, appropriately prolong recovery time and reduce emergence agitation in children undergoing percutaneous renal biopsy.
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