骶管加基础麻醉在小儿下腹部手术麻醉效能及对血流动力学的影响

The Anesthetic Efficacy of Sacral Canal Plus Basic Anesthesia in Pediatric Abdominal Surgery and Its Influence on Hemodynamics

目的探讨骶管加基础麻醉在小儿下腹部手术中的麻醉效能及对血流动力学的影响.方法将92例接受下腹部手术治疗患儿分为研究组与对照组各46例,研究组采用骶管加氯胺酮基础麻醉,对照组采用氯胺酮基础麻醉.结果研究组患儿的氯胺酮用量显著少于对照组,苏醒时间显著短于对照组,不良反应及术后躁动或(和)哭闹例数均显著少于对照组,各项数据的组间比较均有统计学意义(P<0.05或P<0.01);2组患儿在T1时的MAP与HR均显著增高,与T1时比较均有统计学意义(P<0.05),T3时均有一定程度下降,但对照组2指标水平与T1时比较均有统计学意义(P<0.05),另对照组在术中有7例患儿表现出呼吸抑制,T2时的Sp O2显著低于研究组(P<0.05),经正压辅助呼吸处理后逐渐好转.结论骶管加基础麻醉在小儿下腹部手术中具有较好的麻醉效果,与单行氯胺酮基础麻醉比较可明显降低氯胺酮给药剂量,缩短术后苏醒时间,降低患儿不良反应,同时也能更好地维持患儿血流动力学稳定,对降低小儿下腹部手术风险有益,值得在小儿外科临床中推广应用.

Objective To investigate the anesthesia efficacy of sacral canal plus basic anesthesia in pediatric abdominal surgery and its influence on hemodynamics.Methods 92 patients treated with lower abdominal surgery were divided into research group and the control group（n=46）,the patients in the research group were given sacral canal plus ketamine anesthesia,while the patients in the control group were only given with ketamine anesthesia.Results The dosage of ketamine significantly was less,waking time was significantly shorter,adverse reaction and postoperative agitation or（and） crying cases were significantly less in the research group than those in the control group（P 0.05 or P 0.01）.Two groups of children in T2 MAP and HR were significantly increased,compared with the T1,the difference had statistical significance（P〈0.05）.When the T3 all had certain degree of decline,but the control index of two level compared with T1 when still had statistical significance（P〈0.05）,there were 7 cases in the control group during operation showed respiratory depression, the Sp O2 was reduced to below90%, so that when the T2 Sp O2 was significantly lower than group（P 0.05）, after positive pressure breathing treatment the symptoms were gradually improved.Conclusion Sacral canal plus basic anesthesia in pediatric abdominal surgery has good anaesthetic effect, compared with the single ketamine anesthesia, it can obviously reduce the dose of ketamine,shorten time of postoperative revival and reduce adverse reactions to children,but also better able to maintain stable hemodynamics,reduce the risk of children＇s lower abdominal surgery,so it is worth popularization and application in pediatric clinical surgery.