下腹部手术中不同年龄段患儿临床麻醉体会

Experience of clinical anesthesia in lower abdominal surgery in children with different ages

目的 探析下腹部手术中不同年龄段患儿的临床麻醉方法及效果。方法 选择2012年1月—2013年12月择期进行下腹部外科手术的213例患儿,根据不同年龄段分为3组,甲组（0-12个月）32例采用丙泊酚复合氯胺酮进行单纯静脉全麻,乙组（1-6岁）86例采用丙泊酚复合氯胺酮进行骶管阻滞麻醉,丙组（7岁以上）95例采用丙泊酚复合氯胺酮进行硬膜外麻醉,记录并比较3组患儿的苏醒时间、各时段血流动力学情况及术后恶心、呕吐等不良反应发生情况。结果 3组患儿麻醉效果均满意。甲组苏醒时间最长为（62.8±21.4）min,其次为丙组（38.4±16.8）min,乙组苏醒时间最短（34.6±15.2）min,甲组显著高于其它两组,差异有统计学意义（均P〈0.05）;甲组MAP和HR均显著升高,高血压和心动过速人数显著高于乙组和丙组,差异均有统计学意义（均P〈0.05）;甲组恶心呕吐发生率最高15.6%（5/32）,显著高于乙组1.2%（1/86）和丙组2.1%（2/95）,差异均具有统计学意义（均P〈0.05）。结论 不同年龄段患儿进行下腹部手术时应根据生理特点选择合适的麻醉方案,保证手术顺利进行。

Objective To explore the clinical anesthesia method of abdominal surgery in children with different ages and the clinical effects. Methods In our hospital from January 2012 to December 2013,213 cases of elective abdominal surgery were divided into three groups according to different ages： first division group A（ 0 to 12 months）,32 cases with propofol compound ketamine simple intravenous anesthesia; group B（ 1 to 6）,86 cases with propofol compound ketamine for sacral canal blocking anesthesia; and group C（ more than 7）,95 cases of using propofol compound ketamine with epidural anesthesia,the awakening time of three groups of children in each period,the hemodynamic happens and postoperative adverse reactions such as nausea,vomiting were recorded and compared. Results Anesthetic effects in all group were excellent. Group A had the longest time of（ 62. 8 ± 21. 4） min,followed by group C（ 38. 4 ± 16. 8） min,awakening time was the shortest in group B（ 34. 6 ± 15. 2） min,the difference of awakening time among three group were statistically significant（ all P〈0. 05）; MAP and HR in group A were higher,incidence of hypertension and tachycardia in group A were significantly higher than those of group B and C,the difference were statistically significant（ P〈0. 05）; incidence of nausea and vomiting in group A was up to 15. 6%（ 5 /32）,which was significantly higher than that of group B（ 1. 2%,1 /86）and group C（ 2. 1%,2 /95）,the difference was statistically significant（ all P〈0. 05）. Conclusion To children with different age undergoing lower abdominal surgery,the appropriate anesthesia plan should be chosen to ensure the operation smoothly according to physiological characteristics.