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目的评价氯胺酮复合丙泊酚静脉麻醉用于痉挛性脑瘫患儿神经干细胞移植术中的安全性。方法随机选择60例拟行神经干细胞移植术的痉挛性脑瘫患儿,ASAⅠ～Ⅱ级,给予氯胺酮+丙泊酚全静脉麻醉。麻醉诱导:丙泊酚1.5～2 mg/kg+氯胺酮1～2 mg/kg缓慢静推;麻醉维持:丙泊酚以30～40μg.kg-1.min-1、氯胺酮以10～30μg.kg-1.min-1静脉微量泵入维持镇静镇痛。术中观察平均动脉压(MAP)、心率(HR)、呼吸频率(RR),血氧饱和度(SpO2)变化,记录患儿神志消失时间、清醒时间、麻醉效果及不良反应等。结果注药后至清醒各时间点患儿MAP、HR与注药前比较无明显变化。注药后1、3 min时患儿RR减慢,SpO2下降,但与注药前比较差异无统计学意义。患儿神志消失时间为(50.5±9.1)s,清醒时间为(15.3±3.6)min。所有患儿麻醉效果均较满意,无肢体扭动、恶心呕吐、流涎等不良反应;呼吸抑制3例,呛咳1例。结论氯胺酮复合丙泊酚静脉麻醉应用于痉挛性脑瘫患儿神经干细胞移植手术可控性强,不良反应小,安全有效。
Objective To evaluate the safety of ketamine combined propofol intravenous anesthesia for neural stem cell transplantation in children with spastic cerebral palsy. Methods A total of 60 children with spastic cerebral palsy who underwent neural stem cell transplantation were randomly assigned to ASA Ⅰ ~ Ⅱ and received total intravenous ketamine plus propofol anesthesia. Induction of anesthesia: Propofol 1.5 ~ 2 mg / kg + ketamine 1 ~ 2 mg / kg slow intravenous anesthesia maintenance: propofol 30 ~ 40μg.kg-1.min-1, ketamine with 10 ~ 30μg.kg- 1.min-1 venous micropumps to maintain sedative and analgesic. During the operation, mean arterial pressure (MAP), heart rate (HR), respiratory rate (RR) and oxygen saturation (SpO2) were measured. The disappearance of conscious time, awake time, anesthetic effect and adverse reactions were recorded. RESULTS: There was no significant difference in MAP and HR between infants and awake subjects at all time points after injection. At 1 and 3 min after injection, the RR of children decreased and SpO2 decreased, but there was no significant difference between before and after injection. Children with consciousness disappear time was (50.5 ± 9.1) s, awake time was (15.3 ± 3.6) min. All patients were satisfied with the anesthetic effect, no limb writhing, nausea, vomiting, salivation and other adverse reactions; respiratory depression in 3 cases, cough in 1 case. Conclusions Ketamine combined propofol intravenous anesthesia is a safe and effective method for neural stem cell transplantation in children with spastic cerebral palsy.