小儿泌尿外科阴茎部位手术的麻醉处理  

Anesthesia in Pediatric Urologic Surgery Around Penis

作　　者：童易如[1] 卢小燕[1] 朱义[1] 汪丽娜[1] 周星星[1] 张溪英[1] 

机构地区：[1]湖南省儿童医院麻醉科,湖南 长沙410007

出　　处：《医学临床研究》2014年第1期128-130,共3页Journal of Clinical Research

摘　　要：[目的]探讨小儿泌尿外科阴茎手术面罩下静吸复合全麻合并骶管阻滞的麻醉效果及安全性。[方法]将60例择期行泌尿外科阴茎部位手术的患儿随机分为A组和B组各30例，A组选择传统的静脉复合麻醉联合低位硬膜外麻醉，B组选择面罩下静吸复合麻醉联合骶管阻滞。入麻醉恢复室每10 min进行儿童麻醉后躁动（PAED）评分和婴幼儿麻醉后疼痛评分（CHIPPS），观察两组苏醒期躁动发生率及入手术室时（T1）、切皮时（T2）、切皮后5 min（T3）、切皮后15 min（T4）、术毕时（T5）心率（HR）、收缩压（SBP）、脉搏血氧饱和度（SpO2）、呼吸频率（RR）。并观察阴茎根部手术操作及膀胱造瘘时是否需要辅助全麻镇痛药、两组是否存在恶心呕吐、喉痉挛等麻醉不良事件的发生、及B组需要置入口咽通气道的例数。[结果]B组手术开始后各时点 H R均高于A组，B组术中各时点RR均低于A组。A组有76．6％（23/30）患儿在阴茎根部手术操作时需要辅助全麻镇痛药，两组均无苏醒期躁动病例（PAED评分均小于10分）及术后疼痛病例（CHIPPS评分均小于3分），无恶心呕吐、喉痉挛等不良事件发生。B组有23．3％（7/30）患儿需要置入口咽通气道。[结论]面罩下静吸复合全麻合并骶管阻滞能安全有效地用于小儿泌尿外科阴茎部位手术。[Objective] To explore the efficacy and safety of intravenous inhalation anesthesia under face-mask combined with caudal blockage in pediatric penis surgery .[Methods]Totally 60 pediatric patients sched-uled for urological penis surgery were randomly divided into group A and group B with 30 patients in each group .Group A received traditional intravenous anesthesia combined with lower region epidural blockage , while group B received intravenous inhalation anesthesia under facemask combined with caudal blockage .Pedi-atric anesthesia emergence delirium（PAED） score and children and infants postoperative pain scale（CHIPPS） were performed every 10min after entering recovery room .The incidence of restlessness during the recovery time ,heart rate（HR） ,systolic blood pressure （SBP） ,pulse oxygen saturation （SpO2 ） and respiratory rate （RR） at entering operating room T1 ） ,skin incision（T2 ） ,5min after incision（T3 ） ,15min after incision（T4 ） and after operation（T5 ） in two groups were observed .The demand for adjuvant general anesthetic during the operation of the root of penis or cystostomy ,the incidence of adverse events such as nausea ,vomiting and la-ryngospasm and the number of patients who needed the implantation of oral airway in group B were also ob-served .[Results] HR of group B at each time point after incision was higher than that of group A ,while HR of group B during the operation was lower than that of group A .In group A ,76 .6% （23/30） of patients nee-ded adjuvant anesthetic during the operation of the root of penis .No one of two groups had restlessness（PAED score〈10） during the recovery and postoperative pain （CHIPPS score〈3） .No adverse event such as nausea , vomiting and laryngospasm occurred .In group B ,23 .3% （7/30） of patients needed the implantation of oral airway .[Conclusion] Intravenous inhalation anesthesia under facemask combined with caudal blockage can be safely and effectively applied in pediatric urologic surgery around

关 键 词：阴茎 外科学 麻醉 

分 类 号：R697.1[医药卫生—泌尿科学]