经喉罩自主吸入七氟醚用于小儿短小手术麻醉的可行性研究  

Evaluation of the laryngeal mask airway for spontaneous breathing in short pediatric operation under Sevoflurane inhalation anesthesia

作　　者：汪芳俊[1] 胡建华[1] 万勇[1] 孙桂英[1] 蔡蓉[1] 

机构地区：[1]四川省南充市川北医学院附属医院麻醉科,637000

出　　处：《中国小儿急救医学》2015年第5期332-336,共5页Chinese Pediatric Emergency Medicine

摘　　要：目的评价经喉罩自主吸入七氟醚用于小儿短小手术麻醉的可行性。方法选择择期行疝修补术的80例患儿，ASAI～Ⅱ级，采用随机数字表法随机分为喉罩七氟醚自主吸入麻醉组（A组）和机控呼吸七氟醚麻醉组（B组），每组40例。患儿麻醉诱导采用面罩吸入七氟醚，麻醉至足够深度时A组患儿置入喉罩，连接麻醉机并保留自主呼吸，术中单纯吸入七氟醚维持麻醉。B组患儿在吸入诱导后静脉给予顺式阿曲库铵0．15mg／kg，然后行气管插管，连接麻醉机行控制通气吸入七氟醚维持麻醉，手术结束前40min停止使用肌松药。两组患儿均在手术结束前10min停止吸入七氟醚。观察并记录麻醉诱导前1min（T。）以及麻醉诱导后15min（T1）、30min（T2）、45min（T3）、60min（T4）患儿呼气末C02分压（end—tidalcarbondioxidepartialpressure，PETC02）、脉搏氧饱和度、平均动脉血压和呼气末七氟醚浓度。观察并记录术中患儿体动情况，停止七氟醚吸入后记录患儿苏醒和拔管时间，并观察拔管情况。结果A组患儿麻醉后45minPETCO2明显升高，pH明显降低（P〈0．05）；B组患儿麻醉后PETCO2和pH无明显变化。两组患儿麻醉开始后呼气末七氟醚浓度在不同时间点差异无统计学意义（P〉0．05）。A组患儿在麻醉开始后30min和45minPaCO2明显升高，而碱剩余明显降低（P〈0．05），B组患儿麻醉前后PaCO2和碱剩余无明显变化。A组患儿术中有4例出现肢体活动，在拔出喉罩时有2例出现咳嗽和屏气。B组患儿在拔出气管导管时有8例出现咳嗽屏气，4例出现喉痉挛。A组患儿苏醒时间和导管拔除时间均较B组短（P〈0．05）。结论喉罩保留自主呼吸全凭七氟醚吸入麻醉可以用于小儿短小手术麻醉，麻醉苏醒更快，拔管不适反应和并发症更少。麻醉时间达到30min后宜适当手控辅助呼吸，以减轻二氧化碳潴留。Objective To evaluate the effects of the laryngeal mask airway for spontaneous breath- ing in short pediatric operation under Sevoflurane inhalation anesthesia. Methods Eighty children undergo- ing hernia surgery, of whom ASA I or 1I, in accordance with the random number table, were randomly divided into two groups（ each 40 cases） ：the laryngeal mask airway for spontaneous breathing with Sevoflu- rane inhalation anesthesia in group A, and tracheal intubation for controlled ventilation with Sevoflurane inha- lation anesthesia in group B. Children in the two groups were fasting for 6 hours and without drinking for 4 hours before anesthesia. Anesthesia was induced with Sevoflurane inhalation for all patients. The laryngeal mask airway was inserted soon after induction of anesthesia with Sevoflurane inhalation, and anesthesia main- tained with Sevoflurane inhalation in group A. Patients in group B were given cisatracurium 0. 15 mg/kg intravenous injection before tracheal intubation, and anesthesia maintained with Sevoflurane inhalation, 40 minutes before the end of the surgery to stop using muscle relaxant. Ten minutes before the end of the operation to stop Sevoflurane inhalation,in two groups. The end-tidal carbon dioxide partial pressure（ PETCO2 ）, mean blood pressure, heart rate,respiratory rate, pulse oxygen saturation and end-tidal sevoflurane partial pres- sure（PETSev） were recorded one minute before the induction of anesthesia, 15 min, 30 min, 45 rain, and 60 rain after the induction of anesthesia. Both the time to regain consciousness and the time to remove laryngeal mask airway or tracheal catheter were recorded in two groups. Results The mean blood pressure, heart rate decreased in two groups after the induction of anesthesia（ P 〈 0. 05 ）. The value of PaCO2 increased and that of base excess decreased in 30 rain after the induction of anesthesia in group A（ P 〈 0. 05 ）. The value of PETCO2 increased, and that of pH decreased in 45 min after the induction of anesthesia in group A �

关 键 词：喉罩 七氟醚 自主呼吸 吸入麻醉 儿童 

分 类 号：R726.1[医药卫生—儿科]