鼻咽通气道-面罩自主呼吸下丙泊酚-芬太尼-七氟醚静吸复合全麻用于小儿短小手术的效果：与喉罩自主呼吸的比较  

Efficacy of propofol-fentanyl-sevoflurane anesthesia under spontaneous respiration with nasopharyngeai air- way-face mask for pediatric minor surgery： a comparison with laryngeal mask airway

作　　者：吴志云[1] 查本俊[1] 王永盛[1] 张诚华[1] 邓莎[1] 

机构地区：[1]解放军第180医院麻醉科,福建省泉州市362000

出　　处：《中华麻醉学杂志》2013年第2期178-181,共4页Chinese Journal of Anesthesiology

摘　　要：目的比较鼻咽通气道．面罩和喉罩自主呼吸下丙泊酚-芬太尼-七氟醚静吸复合全麻用于小儿短小手术的效果。方法择期腹股沟斜疝高位结扎术患儿72例，采用随机数字表法，将患儿分为2组（n=36）：鼻咽通气道-面罩组（M组）和喉罩组（L组）。静脉注射丙泊酚1．0mg／kg和芬太尼2．0gg／kg，保留自主呼吸，意识消失后扣上面罩，吸人2L／min氧气和3％七氟醚，BIS值50-60时，L组置人2号喉罩，M组经左鼻腔置人鼻咽通气道并扣紧面罩，连接麻醉机行紧闭循环自主呼吸，切皮前5min静脉注射芬太尼1μg／kg，术中吸人七氟醚，维持BIS值40～60。于麻醉诱导前、麻醉诱导后3min、成功置人喉罩或鼻咽通气道即刻、切皮即刻、切皮后3min、拔出喉罩或鼻咽通气道即刻测定MAP、HR、P_ETCO2和SpO2，记录置人喉罩或鼻咽通气道的时间和成功情况、苏醒时间、离开手术室时间及不良反应发生情况。结果与L组比较，插管、拔管时M组MAP、HR降低，置人鼻咽通道时间较短且一次性置人成功率（100％）明显升高，患儿躁动评分及拔管后上呼吸道梗阻发生率明显降低（P〈0．05）。结论鼻咽通气道一面罩自主呼吸下丙泊酚-芬太尼-七氟醚静吸复合全麻用于小儿短小手术，易于建立人工通气道并可维持自主呼吸，对循环功能影响轻微，还可明显减少麻醉恢复期并发症的发生，其效果优于喉罩自主呼吸方式。Objective To compare the efficacy of combined intravenous-inhalational anesthesia with propofol-fentanyl-sevoflurane in children undergoing minor surgery under spontaneous breathing with nasopharyngeal airway-face mask versus laryngeal mask airway （LMA）. Methods Seventy-two children, scheduled for elective high ligation of indirect inguinal hernia, were randomly divided into 2 groups （ n = 36 each） ： nasopharyngeal air- way-face mask group （group M） and LMA group （group L）. Propofol 1.0 mg/kg and fentanyl 2.0 μg/kg were in- jected intravenously. The spontaneous breathing was kept. After lass of consciousness, a face mask was placed for inhalation of pure oxygen at 2 L/min and 3% sevoflurane. When BIS value reached 50-60, a size 2 LMA was in- serted in group L and a nasopharyngeal airway was placed via the left nasal cavity and the face mask was held tight- ly and connected to the anesthesia machine in group M. Anesthesia was maintained with inhalation of 2%-4% sevoflurane. Fentanyl 1 μg/kg was injected intravenously 5 min before skin incision. The concentration of sevoflu- rane was adjusted to maintain BIS value at 40-60 during surgery. Mean arterial pressure, heart rate, partial pres- sure of end-tidal carbon dioxide and pulse oxygen saturation were recorded before induction, at 3 min during induc-tion, immediately after successful insertion of the airway, at skin incision, 3 min after skin incision, and immedi- ately after removal of the airway. The airway insertion time, success rate of insertion at first attempt, emergence time, and adverse reactions were recorded. Results Compared with group L, mean arterial pressure and heart rate were significantly decreased during airway insertion or removal, nasopharyngeal airway insertion time was shortened and the success rate of nasopharyngeal airway insertion at first attempt （100%） was increased, and the agitation score and incidence of obstruction of the upper respiratory tract were decreased in group M （ P 〈 0.05）. Conclu- sion Combin

关 键 词：喉面罩 面罩 麻醉 全身 儿童 鼻咽通气道 

分 类 号：R726[医药卫生—儿科]