快通道麻醉在小儿腹股沟区手术中的临床应用  

Clinical application of fast track anesthesia in pediatric inguinal region surgery

作　　者：莫毅洁[1] 于美钢[1] 马利[1] 梁宁[1] 黄中华[1] 

机构地区：[1]广西壮族自治区人民医院麻醉科,广西南宁530021

出　　处：《现代医药卫生》2013年第3期321-323,共3页Journal of Modern Medicine & Health

基　　金：广西壮族自治区卫生厅科研基金资助项目(Z2011448)

摘　　要：目的探讨选取快通道麻醉技术应用于小儿腹股沟区手术(腹股沟疝囊高位结扎术或鞘状突高位结扎术)能否减少患儿麻醉镇静镇痛药物的用量,减少不良事件的发生和缩短患儿在麻醉后监护病房停留的时间。方法选取腹股沟疝囊高位结扎术或鞘状突高位结扎术的3～6岁患儿148例,分为IV-I组[静脉滴注氯胺酮麻醉诱导使用髂腹下神经阻滞麻醉(IINB)技术]30例、IV-G组(静脉滴注氯胺酮麻醉诱导未使用IIBN技术)30例、IM-I组(肌内注射氯胺酮麻醉诱导使用IIBN技术)45例和IM-G组(肌内注射氯胺酮麻醉诱导未使用IIBN技术)43例,比较各组患儿的临床数据。结果 IV-I组患儿氯胺酮用量最少[(3.65±1.69)mg/kg],IM-G组最多[(7.81±1.24)mg/kg];IV-I组芬太尼用量为1.1μg/kg,IV-G组为2.0μg/.kg,IM-I组为1.2μg/kg,IM-G组为2.0μg/kg;各组中长链脂肪乳丙泊酚注射液用量基本相同。各组术中均无不良事件发生。IV-I组在麻醉后监护病房停留的时间最短[(25.5±5.9)min],IM-G组最长[(51.7±9.0)min]。结论快通道麻醉技术适于小儿腹股沟区手术,符合安全、高效快通道外科的要求。静脉滴注氯胺酮诱导麻醉比肌内注射氯胺酮诱导麻醉也许更适合快通道麻醉技术。Objective To explore whether the clinical application of fast track anesthesia in pediatric region surgery （high ligation of hernia sac or hydrocele high ligation of vaginal process） can reduce the use amount of anesthetic sedative and analgesic drugs in children, reduce the occurrence of adverse events and shorten the residence time in the resuscitation room. Methods 148 children patients with high ligation of inguinal hernia sac or vaginal process and aged 3-6 years old were se- lected and randomly divided into four groups ： group IV-I[intravenous ketamine for anesthesia induction with iliohypogastric nerve and ilioinguinal nerve blocking （IINB） technique, n=30], group IV-G （only intravenous ketamine for anesthesia induction without IINB technique, n=30）, group IM-I （intramuscular ketamine for anesthesia induction with IINB technique,n=45）and group IM-G （only intramuscular ketamine for anesthesia induction without IINB technique ,n=43 ）. The clinical data were compared among the four groups. Results The use amount of anesthetic drug was least in the group IV-I [ （3.65 ＋ 1.69 ）mg/kg] and highest in the the group IM-G[ （7.81~ 1.24 ） mg/kg]. The dose of fentanyl was 1.1 p.g/kg in the group IV-I, 2.0 p.g/kg in the group IV-G, 1.2 p^g/ kg in the group IM-I and 2.0 p.g/kg in group IM-G. The dose of propofol in each group was equivalent. There was no adverse events happened in these four groups. The group IV-I had the shortest residence time in the resuscitation room[ （25.5~5.9）rain], while the group IM-G had the longest residence time[（51.7~9.0）min]. Conclusion The fast track anesthesia teehnque is suitable for the pediatric inguinal region surgery （high ligation of hernia sac or vaginal process） and conforms to the surgery requirements of safety and high efficiency fast track. Intravenous ketamine may he more suitable for anesthesia induction in fast track anesthesia than intramuscular ketamine.

关 键 词：麻醉 方法 儿童 腹股沟 外科学 快通道 

分 类 号：R614[医药卫生—麻醉学]