小儿经内镜逆行胰胆管造影术45例的麻醉分析  

Anesthesia analysis of 45 children undergoing endoscopic retrograde

作　　者：罗颖[1] 刘孝国[2] 周小莲[1] 楼奇峰[3] 俞正伟[1] 易东音[1] 吴艳辉[1] 孙建良[1] 张筱凤[3] 

机构地区：[1]南京医科大学附属杭州医院麻醉科,杭州310006 [2]温州医科大学第二临床医学院 [3]南京医科大学附属杭州医院消化内科

出　　处：《中华消化内镜杂志》2017年第2期108-111,共4页Chinese Journal of Digestive Endoscopy

摘　　要：目的评价小儿经内镜逆行胰胆管造影术（ERCP）术中不同静脉麻醉方式的安全性和有效性，为小儿ERCP提供较为理想的静脉麻醉方式。方法2013年8月至2016年7月，南京医科大学附属杭州医院45例次小儿ERCP纳入回顾性研究分析，汇总静脉麻醉方式和ERCP手术的完成情况、不良反应发生情况、苏醒时间等。结果静脉麻醉下45例次治疗性ERCP均顺利完成，其中17例次（37．8％）患儿（初次行ERCP且体重≥20．0kg或因再次行ERCP且预计手术时间〈30．0min）采用深度镇静方式，其余28例次（62．2％）患儿（初次行ERCP且体重〈20．0kg或因再次行ERCP且预计手术时间≥30．0min）采用气管插管全麻。深度镇静组的患儿，平均苏醒时间（7．2±6．3）min，术中出现1例次（5．9％）体动和2例次（11．8％）脉搏血氧饱合度一过性下降（均保持在95％以上）；气管插管全麻组的患儿，平均苏醒时间（10．5±8．7）min，无麻醉相关不良反应发生。结论深度镇静和气管内插管全麻均可安全有效地用于小儿ERCP的术中麻醉。相比深度镇静方式，气管内插管全麻可确保ERCP操作期间患儿的气道安全和充分氧供，可能是初次行ERCP且体重〈20．0kg或再次行ERCP且预计手术时间≥30．0min的患儿较为理想的静脉麻醉方式。Objective To investigate the safety and effectiveness of different intravenous anesthesia methods for pediatric ERCP. Methods Data of 45 children undergoing ERCP at the Affiliated Hangzhou Hospital of Nanjing Medical University from August 2013 to July 2016, including intravenous anesthesia, the procedure of ERCP, adverse reactions and the waking time were retrospectively studied. Results A total of 45 patients in two groups under intravenous anesthesia successfully underwent ERCP. Seventeen patients （37.8%） whose body weights were over 20 kg and the duration of surgery was predicted less than 30 minutes received deep sedation without airway intubation. Twenty-eight patients （ 62. 2%） with an initial weight of less than 20 kg and the duration of surgery was predicted more than 30 minutes received general anesthesia with airway intubation, In patients with deep sedation, the mean time of waking was 7.2±6. 3 minutes, body movement reaction occurred in 1 case （ 5. 9% ） and with transient decreasing of pulse blood oxygen （ beyond 95%） occurred in 2 cases （11.8%）. In patients receiving endotracheal anesthesia with intubation, the mean waking time was 10. 5±8. 7 minutes without adverse reactions associated with anesthesia. Conclusion Both deep sedation and general anesthesia with airway intubation are safe for pediatric ERCP. However, general anesthesia with airway intubation is an ideal method ensuring the airway safety and oxygen supply for children less than 20 kg undergoing first-time ERCP or the duration of surgery lasting over 30 minutes.

关 键 词：儿童 内镜逆行胰胆管造影术 静脉麻醉 安全性 有效性 

分 类 号：R726.1[医药卫生—儿科]