小儿气管异物取出术3种麻醉方法的比较  

Comparison of three general anesthesia methods for retrieve of endobronchial foreign body in children

作　　者：蔡英敏[1] 薛荣亮[1] 镇路明[1] 刘鸿涛[1] 白洁[1] 张勇[1] 白莉平[1] 肖小玲[1] 

机构地区：[1]西安交通大学第二附属医院麻醉科,710004

出　　处：《国际麻醉学与复苏杂志》2014年第11期991-994,共4页International Journal of Anesthesiology and Resuscitation

基　　金：国家临床重点专科建设项目资助[卫办医政函（2012）650号]

摘　　要：目的 比较3种麻醉方法在小儿气管异物取出术中的特点.方法 采用区段随机法将300例支气管异物患儿随机分为3组（每组100例）：A组（氯胺酮＋哌替啶＋咪达唑仑＋右美托咪定组）、B组（氯胺酮＋芬太尼＋咪达唑仑＋顺式阿曲库铵组）、C组（七氟醚＋丙泊酚＋瑞芬太尼＋司可林组）.记录置入硬质支气管镜所用时间,询问术者置入支气管镜的难易程度,记录因体动或低氧饱和度而使手术暂停的次数.麻醉过程中严密监测脉搏血氧饱和度（oxygen saturation,SpO2）、心率（heart rate,HR）,记录入室（T0）、置镜时（T1）、术毕（T2）、清醒（T3）时的HR、SpO2值,术毕测血气,记录手术时间和苏醒时间.结果 A组患儿T1时HR （106±9）次/min,T2时HR（99±9）次/min,T3时HR（97±10）次/min,苏醒时间（118±10） min,术中有屏气现象,无二氧化碳蓄积现象;与B、C组比较,差异有统计学意义（P＜0.01）;B组患儿苏醒时间（58±7） min,比A组时间短,HR较快,术中无屏气现象,有二氧化碳蓄积现象,与A组、C组比较,差异有统计学意义（P＜0.01）;C组患儿苏醒时间（21±5） min为3组中最短,HR相对平稳,术中无屏气现象,有二氧化碳蓄积现象,与A组、B组比较,差异有统计学意义（P＜0.01）.结论 3种麻醉方法各有特点,应根据患儿的病情及术者的熟练程度选择应用.Objective To compare three general anesthesia methods for retrieve of endobronchial foreign body in children.Methods Three hundred children undergoing endobronchial foreign body retrieve were randomly assigned into three groups：group A （ketamine ＋pethidine ＋midazolam ＋dexmedetomidine）,group B （ketamine ＋fentanyl ＋midazolam ＋cis-atracurium）,group C （sevoflurane ＋propofol ＋remifentanil ＋succinylcholine）.The time required for endobronchoscope insertion,difficulty grade of endobronchoscope placement,and times of the procedure interruption caused by body movement or desaturation were recorded.The artery oxygen saturation （SpO2） and heart rate （HR） were closely monitored during the anesthesia.The HR and SpO2 at entering the OR （T0）,endobronchoscope placement （T1）,and the end of the procedure （T2）,and the time required for consciousness recovery （T3） were observed.The arterial blood-gas analysis was performed at the end of the procedure.The times required for procedure andrecovery were also recorded.Results In group A,HR was （106±9） beats/min,（99±9） beats/min and （97±10） beats/min at observed points of T1,T2 and T3,respectively,time required for recovery was （118±10） min.The breath holding was observed in group A but without carbon dioxide accumulation.In group B,time required for recovery was （58±7） min,Compared to group A and group C,group B had a quicker recovery time and faster HR（P〈0.01）.No breath holding was noted in group B but with obvious carbon dioxide accumulation.Group C had the shortest recovery time （21±5） min,a relative stable HR and no breath holding during anesthesia,but with some extent of carbon dioxide accumulation compared to group A and group C （P〈0.01）.The rate of hypoxemia was not statistically different among three groups.Conclusions The three general anesthesia methods described above have their advantages and disadvantages.They should be selected based on the physical conditions of the patients an

关 键 词：气管异物 麻醉 

分 类 号：R726.1[医药卫生—儿科]