不同年龄段儿童对腹腔镜气腹刺激时七氟烷MACBAR的影响  

Effects of different periods of age on the MACBAR of sevoflurane in children undergoing laparoscopic surgery with carbon dioxide pneumoperitoneum stimulus

作　　者：王琼 杨加辉 杨小霖[2] WANG Qiong;YANG Jia-hui;YANG Xiao-lin(Department of Anesthesiology,North Sichuan Medical College;The Second Affiliated Hospital of North Sichuan Medical College,Nanchong 637000,Sichuan,China)

机构地区：[1]川北医学院麻醉学系 [2]川北医学院第二附属医院,四川南充637000

出　　处：《川北医学院学报》2021年第2期193-196,共4页Journal of North Sichuan Medical College

基　　金：四川省医学会科研基金(S15025);南充市校地合作项目(18SXHZ0161)。

摘　　要：目的:探讨儿科腹腔镜手术中不同年龄亚组对气腹刺激时抑制50%患儿交感肾上腺素能反应的七氟烷最低肺泡有效浓度(MACBAR)的影响。方法:选取拟行腹腔镜疝气修补术和腹腔镜阑尾切除术ASAⅠ-Ⅱ级的儿科患者预计54例,按年龄分为N_(1)组(2~3岁)、N_(2)组(4~6岁)和N_(3)组(7~12岁),每组预计18例。采用七氟烷潮气量法诱导,静脉复合瑞芬太尼1μg/kg、顺式阿曲库铵0.2 mg/kg完成插管。插管后机械控制通气,吸入七氟烷预设浓度维持麻醉。记录气腹刺激后的血流动力学变化,将心率或血压的变化值超过基础值的20%定义为阳性反应,采用改良序贯法测定各组七氟烷的MACBAR值。结果:三组七氟烷MACBAR分别为(3.13±0.08)%、(3.07±0.08)%及(3.10±0.18)%,差异无统计学意义(P>0.05)。23例阳性反应中,平均动脉压和心率变化均为阳性者占65%(15例),仅有MAP变化为阳性者占35%(8例),而仅有HR变化为阳性者占0%(0例)。结论:2~12岁儿童在腹腔镜手术中,以气腹为刺激时其七氟烷MACBAR值较为稳定,无明显年龄差异。Objective:To investigate the effect of different age subgroups on the minimum alveolar effective concentration(MAC)of sevoflurane which blocked adrenergic response(MACBAR)in 50%children with carbon dioxide pneumoperitoneum stimulus.Methods:54 ASA Ⅰ-Ⅱ children undergoing elective laparoscopic hernia repair(LH)or laparoscopic appendectomy(LA)were selected and divided into group N_(1)(2~3 years old),group N_(2)(4~6 years old)and group N_(3)(7~12 years old).We expected 18 cases in each group.The intubation was completed using sevoflurane tidal volume method combined with intravenous remifentanil 1μg/kg and cisatracurium 0.2 mg/kg.Mechanical ventilation was performed after intubation and sevoflurane was inhaled to maintain anesthesia at a preset concentration.Hemodynamic changes after pneumoperitoneum stimulation were recorded and a change in HR or MAP greater than 20% of its base value was defined as a positive reaction.Then MACBAR value of sevoflurane in each group was determined by improved sequential method.Results:The MACBAR of sevoflurane in the groups N 1-N 3 was(3.13±0.08)%,(3.07±0.08)% and(3.10±0.18)%,respectively,and no statistical difference was found among the three groups(P>0.05).There were 23 cases of positive reaction,in which 65%(15 cases)were positive for MAP and HR,35%(8 cases)were positive only for MAP,0%(0 cases)were positive only for HR.Conclusion:The MACBAR of sevoflurane is stable and no significant difference in age in children between 2~12 years old.

关 键 词：七氟烷 最低肺泡有效浓度 序贯法 儿童 肾上腺素能反应 

分 类 号：R614[医药卫生—麻醉学]