咪唑安定复合芬太尼辅助小儿臂丛阻滞麻醉可行性观察

摘要

目的 观察咪唑安定复合芬太尼用于小儿臂丛阻滞镇静镇痛的有效性和安全性.方法 选择ASA Ⅰ-Ⅱ级行上肢手术患儿60例,随机分为观察组30例,静注芬太尼1μg/kg后持续泵注咪唑安定6μg/(kg·min)至患儿达到RamsayⅣ级镇静停止泵注；对照组30例,静注氯胺酮2mg/kg(稀释后1min内缓慢静注).患儿入睡后,观察组、对照组均行肌间沟臂丛神经阻滞.观察两组患儿臂丛操作时及术中体动反应、镇静程度,静脉用药前后、操作时及术中HR、RR、SpO2的变化,术后苏醒时间、不良反应(呼吸抑制、喉痉挛、气道分泌物、躁动等)发生率.结果 两组患儿行臂丛神经阻滞时,观察组出现体动反应1例,对照组0例,两组差异无统计学意义.观察组较对照组术中维持有效镇静RamsayⅢ级以上时间明显延长(P＜0.05)；静脉泵注咪唑安定前后,观察组HR无明显变化(P＞0.05),RR、Sp02稍有下降(其中一过性呼吸抑制1例),吸氧后恢复正常；对照组静脉用药前后HR变化明显(P＜0.01),一过性呼吸抑制2例,辅助呼吸后恢复,SpO2变化无显著差异(P＞0.05).观察组苏醒时间和不良反应发生率明显少于对照组,差异有统计学意义(P＜0.01).结论 咪唑安定复合芬太尼可用于小儿臂丛阻滞麻醉镇静镇痛,并优于氯胺酮静脉麻醉.%Objective To investigate the feasibility and efficacy of midazolam combined with fentanyl for intersealene brachial plexus block in children. Methods Sixty ASA I - II children aged 3-6 years ready for operation of upper limbs were randomly divided into observation group (n = 30) and control group (n = 30). The patients were given midazolam and fentanyl in observation group and ket-amine in control group for sedation and analgesia. The patients' body movement,the degree of sedation,the changes of heart rate( HR), respiratory rate( RR) ,SpO2 ,the postoperative recovery time,the incidence of adverse reactions(respiratory depression, laryngospasm, airway secretions,restlessness) were recorded. Results During the intersealene brachial plexus block,body movement was found in one case in observation group,but not in control group. The time of maitaining the effective sedation was longer in observation group than that in control group(P<0.05). No significant changes in intraoperative sedation level,SpO, and HR after intravenous injection were found in observation group (P>0.05). In control group,HR changed significantly after intravenous injection (P<0.01). Transient respiratory depression happened in one case in observation group and 2 cases in control group,and all recovered after assisted respiration. The awakening time was shorter in observation group than in control group(P <0.01) ,and the incidence of side effects was also lower in observation group than in control group(P<0.0l). Conclusion Midazolam/fentanyl composition can be used in children' s brachial plexus block and the effect is better than ketamine.