咪唑安定复合氯胺酮用于小儿基础麻醉的临床研究

目的　研究咪唑安定复合氯胺酮肌注或口服用于小儿基础麻醉的可能性。方法　 80例 1～ 8岁、ASAⅠ～Ⅱ级的患儿随机等分成四组 :A组 ,肌注氯胺酮 6mg/kg ;B组 ,肌注氯胺酮 4mg/kg +口服咪唑安定 0 2mg/kg ;C组 ,口服氯胺酮 5mg/kg +咪唑安定 0 5mg/kg ;D组 ,口服咪唑安定0 7mg/kg。观察各组麻醉诱导效果、循环呼吸变化及不良反应。 结果　 (1)B组与A组相比 ,起效更快 ,术中不良反应发生率更低 (P <0 0 5 ) ,而麻醉诱导效果无明显差异 (P >0 0 5 ) ;(2 )C组与A组相比 ,小儿更为合作 (P <0 0 1) ,HR增加不明显 (P >0 0 5 ) ,但起效更慢 (P <0 0 5 ) ,镇静程度不如后者 (P <0 0 5 ) ,但 80 %的患儿尚能与父母分离。结论　咪唑安定复合氯胺酮肌注用于小儿麻醉诱导要优于单纯肌注氯胺酮 ,而咪唑安定复合氯胺酮口服仍不失为一种可行的诱导方法。

A clinical study of muscular injection or oral administration of midazolam combined with ketamine for induction in children

Objective To investigate the possibility of muscular injection ororal administration of midazolam combined with ketamine for the induction in children．Methods 80 children，aged 1 to 8，ASAgrades Ⅰ－Ⅱ，were divided randomly into four groups：group A， ketamine 6mg／kg im，group B，ketamine 4mg／kg ＋midazolam 0.2mg／kg im， group C，ketamine 5mg／kg ＋midazolam 0.5mg／kg po，group D，midazolam 0.7mg／kg po． The efficacy of anesthsia induction，hemodynamic and respiratory changes and side effects of the drugs administered were observed．Results （1）Compared to group A，group B experienced faster onset and fewer side effects （P＜0.05），while the efficacy of induction had no significant difference （P＞0.05）．（2）Compared to group A，children in group C could cooperate better with out obvious heart-rate increase （P＞0.05），but experienced slower onset and worse induction quality （P＜0.05）．80％ of patients in group C could separate from their parents．Conclusion Intramuscular injection of midazolam combined with ketamine is a better method than ketamine im alone for basic anesthesia in child．Oral administration of midazolam combined with ketamine is still an alternative method．