七氟烷与普鲁泊福联合氯胺酮用于腹腔镜下小儿腹股沟斜疝手术麻醉的比较  

Comparison with sevoflurane inhalation and propofol combined with ketamine total venous anesthesia in pediatric laparoscopic surgery of oblique inguinal hernia

作　　者：蔡晓雷[1] 甘果[1] 袁力勇[1] 傅虹[1] 孙志强[1] 

机构地区：[1]宁波市妇女儿童医院麻醉科,315012

出　　处：《中国医师进修杂志》2010年第6期1-4,共4页Chinese Journal of Postgraduates of Medicine

基　　金：宁波市医学科技项目（2007014）;宁波市优秀中青年卫生技术人才项目（2007201）

摘　　要：目的比较七氟烷（S）吸入与普鲁泊福（P）联合氯胺酮（K）全凭静脉麻醉用于腹腔镜下小儿腹股沟斜疝手术的麻醉诱导、维持及苏醒特征，为该类手术选择合适的麻醉方式提供依据。方法ASA分级I级、择期行腹腔镜下腹股沟斜疝手术患儿70例，按随机数字表法分为S组与P联合K组（PK组），每组各35例。S组采用吸入S诱导，气管插管后仅吸入S，保持S吸入浓度在1．0～1．5最低肺泡有效浓度（MAC）；PK组采用肌肉注射K6mg／kg诱导，气管插管后静脉泵注P80μg/（kg·min）和K20μg/（kg·min）。比较两组患儿麻醉诱导时间、拔除气管导管时间、苏醒时间；麻醉各时间点患儿的心率、平均动脉压（MAP）、脉搏血氧饱和度（SpO2）；苏醒期、术后1～2d患儿不良反应的发生率。结果s组患儿麻醉诱导时间、拔除气管导管时间及苏醒时间均短于PK组（P〈0．05）；S组苏醒期躁动发生率（20．0％，7／35）高于PK组（2．9％，1／35）（P〈0．05）；术后1dPK组恶心（17．1％，6／35）、呕吐（31．4％，11／35）及睡眠质量差（543％，19／35）的发生率高于S组（均为2．9％，1／35）（P〈0．05）；术后2dPK组睡眠质量差（143％，5／35）的发生率仍高于S组（0）（P〈0．05）。S组及PK组患儿麻醉插管及维持期间循环稳定，S组拔除气管导管时MAP和心率明显升高。结论吸入S或P联合K全凭静脉麻醉用于腹腔镜下小儿腹股沟斜疝手术各有优缺点，仍需从麻醉方式、药物组合等角度筛选出更适合该类手术的麻醉技术。Objective To evaluate sevoflurane inhalation and propofol combined with ketamine total venous anesthesia in pediatric laparoscopic surgery of oblique inguinal hernia. Methods Seventy ASA I children were randomly divided into two groups, 35 children in every group.Children in group S were applied sevoflurane inhalation [ the minimum alveolar concentration （MAC） of sevoflurane was 1.0-1.5 ], children in group PK were applied ketamine inhalation and total venous anesthesia ofpropofol [ 80 μg/（kg·min） ] with ketamine [ 20μg/（ kg·min ）]. Compared the time of anesthesia induction, tracheal catheter extubation, anesthesia recovery between the two groups. The mean arterial pressure （MAP）, heart rate, pulse oxygen saturation （SpO2） during anesthesia were compared. During 2 days after operation, the adverse effects such as nausea and vomit, lower grade of sleep quality were also compared. Results Compared with group PK,the time of anesthesia induction, tracheal catheter extubation and anesthesia recovery in group S were shorter （P 〈 0.05 ）, the incidence of emergence agitation in group S was higher （20.0%, 7/35 vs 2.9%, 1/35 ） （P 〈 0.05 ）. But nausea （ 17.1%, 6/35 ）, vomit （ 31.4%, 11/35 ） and lower grade of sleep quality （ 54.3%, 19/35 ） were higher in group PK than those in groups （all 2.9%, 1/35） at 1 day after operation （P〈0.05）. The incidence of lower grade of sleep quality at 2 days after operation in group PK（ 14.3%, 5/35 ） was higher than that in group S （0）（P 〈 0.05）. Cardiovascular effects of children, such as MAP and heart rate during the period of tracheal catheter extubation in group S was higher than that in group PK. Conclusion Sevoflurane inhalation and propofol combined with ketamine total venous anesthesia in pediatric laparoscopic surgery of oblique inguinal hernia still has some disadvantages, the anesthesia technology is selected by anesthesia method and medicine combination.

关 键 词：腹腔镜 疝 腹股沟 七氟烷 普鲁泊福 氯胺酮 

分 类 号：R726[医药卫生—儿科]