延缓排除笑气对小儿七氟醚全凭吸入麻醉术后苏醒期的影响  

Effect of delayed nitrous oxide wash out on recovery period after sevoflurane anesthesia in children

作　　者：王杰[1] 陈宏志[1] 谢亚英 WANG Jie;CHEN Hongzhi;XIE Yaying(Department of Anesthesiology,the Affiliated Shengjing Hospital of China Medical University,Shenyang 110000,China)

机构地区：[1]中国医科大学附属盛京医院麻醉科,辽宁沈阳110000

出　　处：《大连医科大学学报》2018年第1期54-59,共6页Journal of Dalian Medical University

基　　金：辽宁省自然基金面上项目(201421087)

摘　　要：目的探究延缓排除笑气对小儿眼科短小手术术后苏醒期的影响。方法选取择期全麻下行眼科短小手术、ASA I^II级、1~3岁患儿60例,随机分成两组:即刻排除笑气组(I组)和延缓排除笑气组(D组),每组30例。手术完成即刻,新鲜气体流量改成6 L/min。I组即刻停止吸入七氟醚和笑气,改为吸入33%的氧气与空气的混合气体(Fi O2=0.33);D组即刻停止吸入七氟醚,继续吸入笑气,待MAC值降至0.6时,改为吸入33%的氧气与空气的混合气体(Fi O2=0.33)。待患儿达到拔管条件,拔出气管导管送入PACU。记录两组患儿拔管时呼气末七氟醚浓度(ETSevo)、呼气末笑气浓度(ETN2O)、BIS值和MAC值。对两组患儿在入PACU即刻及之后每间隔5 min至30 min时的术后躁动情况进行PAED躁动评分、Ramsay镇静评分,记录围术期不良事件。结果 D组患儿在拔管时ETSevo浓度低于I组(P<0.05);D组患儿在拔管时ETN2O浓度高于I组(P<0.05);D组患儿在入PACU即刻、入PACU后5 min及10 min的PAED躁动评分低于I组,差异有统计学意义(P<0.05)。结论择期行眼科短小手术的患儿,在苏醒期延缓笑气的排除,可以改善小儿术后苏醒期质量。Objective To investigate the effect of delayed nitrous oxide wash out on recovery period after anesthesia for minor ophthalmology surgery in children.Methods The study enrolled 60 children,who were 1-3 years old,classified as ASA physical status I-II,and scheduled for minor ophthalmic surgery.The patients were randomly allocated to either the immediate wash out nitrous oxide group(group I=30 cases)or the delayed wash out nitrous oxide group(group D=30 cases).At the end of the surgery,the fresh gas flow was adjusted to 6 L/min.In the group I,sevoflurane was discontinued and the inspired N 2O was replaced with air(FiO 2=0.33).In the group D,sevoflurane was discontinued but N 2O was continued until the MAC value decreased to 0.6,when the inspired N 2O was replaced with air(FiO 2=0.33).The endotracheal tube was extubated until the children meet the indication of extubation.At that time,the end-tidal sevoflurane and nitrous oxide concentrations and the value of BIS and MAC were measured.After arriving at PACU,the PAED score and the Ramsay score were recorded every 5 minutes.The perioperative adverse reactions were observed.Results The end-tidal concentration of sevoflurane at extubation was significantly lower in the group D than that in the group I(P<0.05).The end-tidal concentration of nitrous oxide at extubation was higher in the group D than that in the group I(P<0.05).The PAED scores were significantly lower in the group D arriving at PACU and after 5min、10min(P<0.05).Conclusion Delayed nitrous oxide wash out in recovery period can improve the quality of postoperative recovery in children.

关 键 词：七氟醚 笑气 小儿麻醉 苏醒期躁动 眼科短小手术 

分 类 号：R614[医药卫生—麻醉学]