早产儿行激光光凝术的麻醉体会  

Experience on Anesthesia of Premature Infants Undergoing Laser Photocoagulation

作　　者：曾焱[1] 陈春燕[1] 成黎明[1] 苗琼[1] 谢超 张玉龙 ZENG Yan;CHEN Chunyan;CHENG Liming;MIAO Qiong;XIE Chao;ZHANG Yulong(Department of Anesthesiology,Kunming Children Hospital,Kunming 650034,China)

机构地区：[1]昆明市儿童医院麻醉科,云南昆明650034

出　　处：《中国医药科学》2018年第20期133-136,共4页China Medicine And Pharmacy

基　　金：云南省昆明市卫生科技人才培养项目暨"十百千"工程[2016-sw(后备)-76]

摘　　要：目的回顾总结早产儿行激光光凝术的麻醉。方法选取2016年1月～2017年9月就诊于我院的早产儿视网膜病变患儿20例,ASAⅢ～Ⅳ级,周龄33～47周,体重1.3～4.5kg。所有患儿均采用七氟烷诱导,行气管插管,再以七氟烷维持麻醉,复合小剂量静脉全麻;其中七氟烷复合丙泊酚15例,七氟烷复合依托咪酯5例。术毕带管送入PACU,清醒拔管后送回病房。计量资料组间采用t检验,计数资料采用χ~2检验,比较入室时、插管时、及出室时的HR、BP、和SpO_2的情况;以及复合的静脉药的用量、手术时间、拔管时间、以及术后发生呼吸暂停的例数的情况。结果入室时、插管时、及出室时的HR、BP的比较,差异无统计学意义(P> 0.05);而插管时的SpO_2与入室时和出室时比较,差异有统计学意义(P <0.01)。七氟烷复合丙泊酚组与七氟烷复合依托咪酯组相比,拔管时间、PACU停留时间,差异有统计学意义(P <0.05);而手术时间差异无统计学意义(P> 0.05),两组术后均未出现呼吸暂停。结论以七氟烷吸入为主,复合小剂量静脉麻醉药(丙泊酚等),是早产儿行激光光凝术的一种行之有效的麻醉方法,但注意气管插管时容易出现SpO_2下降的情况。Objective To review and summarize anesthesia of premature infants undergoing laser photoeoagulation. Methods Twenty premature infants with retinopathy who were treated in our hospital from January 2016 to September 2017 were selected.Their ASA was Ⅲ- Ⅳ level and they were 33-47 weeks old and weight 1.3 to 4.5 kg.All infants were given sevoflurane induetion,endotraeheal intubation,sevoflurane maintenance anesthesia combined with low-dose intravenous anesthesia.15 infants were given sevoflurane combined with propofol and 5 infants were given sevoflurane combined with etomidate.After the operation,they were sent to the post-anesthesia care unit （PACU） with intratraeheal tube and they were sent back to the ward after extubation when they were was awake.T test was used between the measurement data sets and ehi-square test was used for counting data.HR,BP and SpO2 at entry,intubation,and extubation were compared. The amount of combined intravenous drug,operation time,extubation time and the number of eases of postoperative apnea were also compared. Results There was no statistically significant difference in HR and BP at entry,intubation,and extubation （P 〉 0.05）.SpO2 at intubation was different with SpO2 at entry and extubation and the difference was statistically significant （P 〈 0.01）.Extubation time and PACU stay in the sevoflurane combined with propofol group and sevoflurane combined with etomidate had difference and the difference was statistically significant （P 〈 0.05）.Difference in operation time had no statistical significance （P 〉 0.05）.There was no ease with postoperative apnea in two groups. Conclusion Sevoflurane inhalation combined with low-dose intravenous anesthetics （propofol,ete.） is an effective anesthesia method for laser photoeoagulation of premature infants,but it should note that SpO2 is prone to decline during tracheal intubation.

关 键 词：婴儿 早产 视网膜疾病 七氟烷 全身麻醉 

分 类 号：R726.1[医药卫生—儿科]