小剂量丙泊酚或氯胺酮对小儿扁桃体切除术麻醉苏醒后咳嗽的影响

张浩然; 张运淳

doi:10.13898/j.cnki.issn.1000-2200.2021.05.021

小剂量丙泊酚或氯胺酮对小儿扁桃体切除术麻醉苏醒后咳嗽的影响

Effect of the low-dose propofol or ketamine on coughing in children treated with tonsillectomy after recovery from anesthesia

摘要

摘要:
目的观察小剂量丙泊酚或氯胺酮对小儿扁桃体切除术麻醉后咳嗽的影响。
方法选择择期行扁桃体切除术小儿90例，ASA Ⅰ~Ⅱ级，随机分为丙泊酚组（P组），氯胺酮组（K组），各45例。2组患儿于手术结束后分别给予静脉注射小剂量丙泊酚（0.5 mg/kg）和小剂量氯胺酮（0.5 mg/kg），待患儿手术结束入监护室记录拔管后各时间段T₀（拔管时）~T₁（拔管后5min）、T₁~ T₂（拔管后10 min）、T₂~ T₃（拔管后15 min）、T₃~ T₄（拔管后20 min）、T₄~ T₅（拔管后25 min）、T₅~ T₆（拔管后30 min）咳嗽的发生率。分别于术后10、20、30、60 min以及2、4、8 h时间点记录术后疼痛评分，并记录患儿术后恶心呕吐的发生率。
结果P组各时间段咳嗽发生率均低于K组，术后10、20、30、60 min时间点疼痛评分均高于K组，术后恶心呕吐发生率低于K组，差异均有统计学意义（P < 0.05~P < 0.01）。
结论对于进行扁桃体切除术的儿童，在麻醉结束后静脉注射0.5 mg/kg的低剂量丙泊酚较注射0.5 mg/kg的低剂量氯胺酮能更有效地降低麻醉后咳嗽、恶心呕吐的发生率，但镇痛效果不如氯胺酮。

Abstract:
ObjectiveTo observe the effects of low dose propofol or ketamine on cough in children treated with tonsillectomy after recovery from anesthesia.
MethodsNinety ASA Ⅰ-Ⅱ patients scheduled by tonsillectomy were randomly divided into the propofol group(group P) and ketamine group(group K)(45 cases each group).The group P and group K were intravenously injected with low dose propofol(0.5 mg/kg) and ketamine(0.5 mg/kg) at the end of anesthesia, respectively.After the operation, the occurrence rates of cough in two groups were recorded at T₀, T₀-T₁, T₁-T₂, T₂-T₃, T₃-T₄, T₄-T₅ and T₅-T₆T₀(at the time of extubation), T₁(after 5 min of extubation), T₂(after 10 min of extubation), T₃(after 15 min of extubation), T₄(after 20 min of extubation), T₅(after 25 min of extubation) and T₆(after 30 min of extubation).The pain scores in two groups were recorded after 10 min, 20 min, 30 min, 1 h, 2 h, 4 h and 8 h of operation, respectively.The incidence rate of postoperative vomiting in two groups were recorded.
ResultsThe incidence rates of cough in group P at each time-point were lower than that in group K, the pain scores in group P after 10 min 20 min 30 min of operation were higher than that in group K, and the incidence rate of postoperative vomiting in group P was lower than that in group K(P < 0.05 to P < 0.01).
ConclusionsFor children treated with tonsillectomy, compared with 0.5 mg/kg of low-dose ketamine the intravenous injection of 0.5 mg/kg of low-dose propofol after anesthesia can effectively reduce the cough, and incidence rates of nausea and vomiting, but the analgesic effect of propofol is not as good as ketamine.

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