七氟醚复合骶管阻滞在婴幼儿先天性巨结肠根治术中的应用  

Application of sevoflurane combined with sacral anesthesia during primary laparoscopic pull-through operation for Hirschsprung's disease in infants

作　　者：孙艳玲[1] 吴五洲[2] 许先成[1] 王燕[1] 

机构地区：[1]郧阳医学院附属太和医院麻醉科,湖北十堰442000 [2]郧阳医学院附属太和医院骨科,湖北十堰442000

出　　处：《现代医学》2010年第4期352-355,共4页Modern Medical Journal

摘　　要：目的:评价七氟醚复合骶管阻滞用于婴幼儿腹腔镜先天性巨结肠根治术的麻醉效果。方法:选择经腹腔镜行先天性巨结肠根治术患儿40例,随机分为七氟醚复合骶管阻滞组(S组)和基础+全麻组(K组),每组20例,观察并记录两组患儿麻醉诱导、术中维持、麻醉苏醒各时期血流动力学变化、麻醉效果、不良反应,对所得数据进行统计学分析。结果:诱导时间S组明显短于K组(P<0.05);静脉穿刺时40例患儿均配合,S组无一例出现逃避、肢体运动,K组有1例患儿有肢体运动;K组8例患儿有呼吸道分泌物增多现象,S组无此现象;两组患儿术中镇痛均较满意,血流动力学平稳,麻醉恢复期S组不良反应明显少于K组。结论:吸入七氟醚复合骶管阻滞有利于呼吸、循环的管理及术后苏醒,是一种安全有效、方便快捷的技术,是婴幼儿先天性巨结肠手术较为理想的麻醉方法。Objective：To investigate the anesthesia effects of infants who performed primary laparoscopic pullthrough operation for Hirschsprung＇s disease（HD） under anesthesia with sevofurane and sacral block.Methods：40 infants（age：8 to 36 months） with HD were divided randomly into sevoflurane group（S group,n = 20） and ketamine group（K group,n = 20）.All the patients were unpremedicated.In the S group,the induction of anesthesia was strated with 6% sevoflurane and fresh gas flow rate was 6 L·min-1.The inspired concentration of sevoflurane was reduced to 2 minimal alveolar concentration（MAC） as soon as eye-lash reflex of the infants was abolished,then atropine 0.02 mg·kg-1,fentany 2 μg·kg-1 and atracrium 0.6 mg·kg-1 were induced.Whereas in the K group,ketamine 5 mg·kg-1 intramuscular injection before atropine 0.02 mg·kg-1,fentany 2 μg·kg-1 and atracrium 0.6 mg·kg-1 infusion.After intubation,sacral block was induced in the S group and the exhalant concentration of sevoflurane was maintained as 1 MAC.Induction of anesthesia was supplemented by propofol at 48 μg·kg-1·min-1 in the K group.Blood pressure（BP）,heart rate（HR） and pulse oxygen saturation（SpO2） were measured immediately before and after intubation,before operation,5 minutes after pneumoperitoneum,at the operation termination and at the time of decannulation.The time of loss consciousness（LOC） and time of analepsia was recorded.Results：Compared with baseline,BP and HR were little decreaced in the S group,but was not significant（P 0.05）.Inversely,both were significantly increased in the K group（P 0.05）.BP and HR returned to the baseline levels after intubation,there was no significant difference in BP and HR between the two groups.The time of LOC and analepsia was significantly shorter in group S than in group K（P 0.05）.Conclusion：Induction of anesthesia with sevoflurane,combined with sacral block is easy accepted by infants.It is a safe,effective and convenient technique during primary laparoscopic

关 键 词：七氟醚 骶管阻滞 先天性巨结肠 腹腔镜 

分 类 号：R656.9[医药卫生—外科学] R246.4[医药卫生—临床医学]