小儿气道异物支气管镜取出术静脉麻醉的选择  

The Choice of Intravenous Anesthesia during the Bronchoscopic Exam for Foreigh Boclies in the Airtract in Children

作　　者：张旭[1] 陈英子[1] 

机构地区：[1]复旦大学附属眼耳鼻喉科医院麻醉科,200031

出　　处：《中国眼耳鼻喉科杂志》2004年第3期168-169,共2页Chinese Journal of Ophthalmology and Otorhinolaryngology

摘　　要：目的观察小儿气道异物作支气管镜检查,比较异丙酚联合羟丁酸钠与单用异丙酚静脉麻醉效应与并发症。方法随机将ASAI-Ⅱ级患儿85例分为Ⅰ、Ⅱ组,Ⅰ组(40例)经异丙酚2.5～5 mg/kg诱导,Ⅱ组(45例)以羟丁酸钠50～80 mg/kg联合异丙酚2.5 mg/kg诱导,术中根据麻醉深度追加异丙酚,观察术中HR、SPO2、手术时间、苏醒时间、追加异丙酚量、并发症(舌下坠、喉痉挛)。结果Ⅰ组置管成功率明显低于Ⅱ组(P<0.05),两组患儿置管后心率都有增加,置管后心率Ⅰ组比Ⅱ组增加显著,差异有统计学意义(P<0.05),Ⅰ组异丙酚追加量明显大于Ⅱ组,氧饱和度下降率和术中呛咳、喉痉挛发生率显著高于Ⅱ组(P<0.01)。两组舌下坠与术后恶心呕吐发生率无统计学差异(P>0.05)。结论异丙酚联合羟丁酸钠比单用异丙酚更适合于小儿气道异物取出术的检查。Purpose To observe the anesthetic effect and complications of sodium hydroxybutyrate combined with propofol and single propofol during the bronchoscopic exam for foreign bodies in the airway in children. Methods Eighty-five ASA grade Ⅰ- Ⅱ patients were randomly allocated to two groups.In group Ⅰ( 40 patients) ,anesthesia was induced by single propofol 2.5-5 mg/kg and in group Ⅱ (45 patients) by sodium hydroxybutyrate 50-80 mg/kg combined with propofol 2.5 mg/ kg. More propofol were added when necessary. The intraoperative heart rate(HR),pulse oxygen saturation(SPO2) ,operating time, recovery time, the supplemental consumption of propofol and complications (glossoptosis and laryngospasm) were recorded. Results In group Ⅰ,the success rate of first insertion of bronchoscopy was lower than in group Ⅱ ( P < 0.05) . Both in group Ⅰand Ⅱthe HR increased significanly after intubation. Compared with group Ⅱ, the increasement of HR after intubation was significantly high ( P < 0.05), so did the supplemental dose of propofol, the decrease rate of SPO2 and the incidence of intraoperative coughing and laryngospasm ( P < 0.01) . The incidence of glossoptosis and postoperative nausea and vomit illustrated no significant difference between the two groups ( P > 0.05). Conclusion The use of sodium hydroxybutyrate combined with propofol for the bronchoscopic exam for foreign bodies in the airway in children is superior to the single use of propofol.

关 键 词：小儿 气道异物 支气管镜 异物取出术 静脉麻醉 

分 类 号：R768[医药卫生—耳鼻咽喉科]