摘要
目的:探讨喉罩吸入(七氟醚和笑气)麻醉在小儿短小手术麻醉中的使用方法及利弊。方法:选择50例择期手术患儿随机分为两组,即喉罩组(Ⅰ组,25例)和全凭静脉麻醉(Ⅱ组,25例),Ⅰ组患儿吸入七氟醚和笑气(2L/min),每呼吸2～3次手动调节七氟醚蒸发罐浓度增加1%,最大至4%,麻醉至足够深度时,进行静脉输液,然后静脉给予异丙酚2mg·kg-1,芬太尼2ug/kg后,置入喉罩,并连接rager/Fabius型麻醉机,给予手控呼吸,待患儿呼吸恢复后,让其自主呼吸,根据患儿的血压、心率变化及时调节吸入浓度,至手术结束前5～10min控制在1%～2%,直至手术结束时停止。Ⅱ组采用异丙酚(2～8mg·kg-1·h-1)和氯胺酮(1～2mg·kg-1·h-1)持续静脉泵注,2种药物不混合。术中保留自主呼吸,面罩给氧2～3L/min。术毕停止静脉泵注麻醉药。在呼吸道通畅和SpO2>95%时,患儿苏醒后送返病房,全程密切观察分别记录两组患儿MAP、HR及SpO2,分别于诱导前、切皮、术中和术毕记录上述指标;并记录强刺激引起的肢体活动、SpO2<95%和PONV发生的例数。结果:两组患儿在麻醉诱导前及lma置入前后的map、hr、spo2值相比较无显著差异(p>0.05),术中及术后map、hrPONV也无显著差异(p>0.05),SpO2<95%Ⅰ组无一例发生肢体活动,SpO2<95%2例(8%),经调整喉罩位置并辅助呼吸后SpO2>95%。Ⅱ组发生肢体活动9例(36%),SpO2<95%7例(28%),明显高于Ⅰ组(P<0.05)。结论:喉罩通气装置使用简单、无创伤,喉罩吸入(七氟醚和笑气)较全凭静脉麻醉更安全,对大多数小儿都适用,在小儿短小手术麻醉中的应用值得推广。
Objective：To probe the advantage and the disadvantage between total intravenous anaesthetsia （tiva） and laryngeal mask airway （lma） in pediatric anaesthetic practice during the short term operation. Methods： Fifty children scheduled for elective surgical intervention were randomly divided into ventilated group with lma （n =25） and tiva group （n =25）. anesthesia was induced with inspired sevoflurane and nitrous oxide （2L/min） then give fentanyl （2.0μg/kg） ,propefol （ 2.0 mg/kg） and parameter map, hr and apo2 were measured and analyzed statistically before induction of anesthesia, before and after insertion of 1ma （tt） and after removal of 1ma （tt）. Results：There were no significant differences in map,spo2 and hr between the two groups before the process （p 〉0.05） ,while in the time after the placement and the removal of 1ma or tiva, map and hr of lma group were significantly lower than that of fiva group （ p 〈 0.05 ）. Conclusion： Lma can be widely applled to pediatric anesthesia for its easy operation and non - invasion.
出处
《医学信息（中旬刊）》
2010年第5期1025-1026,共2页
Medical Information Operations Sciences Fascicule
关键词
喉罩
吸入麻醉
小儿
全凭麻醉
Laryngeal mask airway
Inhalation
Pediatrics
Total intravenous anaesthesia
