基础加腰-硬联合麻醉在小儿腹腔镜手术中的应用  

Basal Anesthesia Plus Combined Spinal-epidural Anesthesia for Laparoscopic Surgery in Children

作　　者：谈应华[1] 

机构地区：[1]中国人民解放军第一七一医院麻醉科,江西九江332000

出　　处：《实用临床医学（江西）》2011年第9期43-44,61,共3页Practical Clinical Medicine

摘　　要：目的探讨基础加腰-硬联合麻醉用于小儿腹腔镜下腹部手术的可行性、安全性和实用性。方法选择5～12岁ASAⅠ-Ⅱ级腹腔镜下行阑尾切除、斜疝修补、精索静脉曲张切除患儿100例,按随机数字表法分为2组,每组50例。A组采用常规气管插管静吸复合全麻;B组采用基础麻醉后行腰-硬联合麻醉,常规紧闭面罩给氧、辅助呼吸。术中连续监测HR、MAP、SpO2、PETCO2。结果 2组患儿术中安静、麻醉满意、肌松良好。气腹后HR、MAP、SpO2、PETCO2均高于气腹前(P<0.05),但尚在正常范围,组间比较无明显差异(P>0.05),放气后10min上述参数恢复至气腹前水平。苏醒时间A组为(42±16)min,明显长于B组的(20±19)min(P<0.05)。结论基础加腰-硬联合麻醉用于手术时间较短的腹腔镜小儿下腹部手术效果确切,对呼吸循环的影响轻,术毕苏醒快,是可行的麻醉方法。ObjectiveTo investigate the feasibility,safety and practicability of basal anesthesia plus combined spinal-epidural anesthesia in laparoscopic surgery of lower abdomen in children.MethodsOne hundred children（5-12 years old,ASA Ⅰ-Ⅱ）undergoing laparoscopic surgery for appendectomy,inguinal hernia repair or varicocele excision were randomly divided into two groups.Group A（50 children） received tracheal intubation inhalation anesthesia.Group B（50 children） received combined spinal-epidural anesthesia following basal anesthesia and ventilatory support by conventional oxygen mask.Parameters,including heart rate（HR）,mean arterial pressure（MAP）,oxygen saturation（SpO2） and end-tidal carbon dioxide（PETCO2）,were monitored continuously during operations.ResultsAll patients were quiet during operations and achieved satisfactory anesthesia with good muscular relaxation.HR,MAP,SpO2 and PETCO2 obviously increased after pneumoperitoneum（P0.05）,but returned to normal levels within 10 minutes after deflation.There were no significant differences in these parameters between the two groups（P0.05）.Compared with group B,the average recovery time significantly increased in group A [（42±16） minutes vs（20±19） minutes,P0.05].ConclusionBasal anesthesia plus combined spinal-epidural anesthesia is feasible and effective for laparoscopic abdominal surgery,and exerts little influence on respiration and circulation with short recovery time in children.

关 键 词：麻醉 腰-硬联合 麻醉 全身 儿童 腹腔镜 

分 类 号：R614.2[医药卫生—麻醉学]