七氟醚和氟烷麻醉对小儿斜视矫正术中眼心、眼呼吸反射程度的比较

Comparison of incidence of oculocardiac and oculorespiratory reflexes during sevoflurane or halothane anesthesia for strabismus surgery in children

目的比较七氟醚(Sevoflurane)和氟烷(Halothane)对小儿斜视矫正术眼心、眼呼吸反射程度的影响。方法60例2￣8岁拟在吸入全麻下行斜视矫正术的小儿随机分为七氟醚-N2O-O2麻醉组(S组,n=30)和氟烷-N2O-O2麻醉组(H组,n=30),所有小儿均使用喉罩并保留自主呼吸。分别于手术野消毒铺单后和牵拉眼肌期间记录眼心反射(oculocardiacreflex,OCR)指标(HR,心律失常、MAP)和眼呼吸反射(oculorespiratoryreflex,ORR)指标(RR,SpO2,PETCO2)。以消毒铺单后的数值作基础值。结果S组基础HR高于H组[SvsH(:119±23)v(s108±20),P<0.05];与基础值比较,牵拉眼肌期间两组病人HR急剧降低[S(:119±23)(vs95±13),P<0.01;H(:108±20)(vs75±15,P<0.01],但OCR期间S组最低HR明显高于H组[SvsH(:95±13)v(s75±15),P<0.01];S组OCR发生率和OCR期间心律失常发生率均明显低于H组(OCR发生率:SvsH:41%vs79%,P<0.01,心律失常发生率:SvsH:4%vs20%,P<0.01)。两组病人OCR期间RR明显低于基础值[S(:32.3±3.0)(vs38.0±2.2),P<0.05,H(:28.0±3.7)v(s34.5±3.0),P<0.05],但S组基础RR和OCR期间最低RR均高于H组(P<0.05)。结论小儿斜视矫正术中,部分小儿经历了急剧的眼心、眼呼吸反射。七氟醚组眼心、眼呼吸反射程度明显低于氟烷组,七氟醚是用于小儿斜视矫正术较安全的一种新型吸入麻醉剂。

[Objective] The incidence of the oculocardiac and oculorespiratory reflexes during sevoflurane or halothane anesthesia for strabismus surgery in children is compared. [Method] Sixty children, 2-8 year old, having strabismus operation were randomized to sevoflurane group（S group, n=30） or Halothane group （H group, n=30）. The two group children received sevoflurane-N2O-O2 and halothane-N2O-O2 anesthesia respectively. Laryngeal mask airway （LMA） was used to secure respiratory airway and maintain spontaneous breathing in all children. Heart rate（HR）, arrhythmlas, mean arterial pressure（MAP） and respiratory rate（RR）, SpO2, PETCO2 were recorded after operative field sterilized（as baseline） and during ocular muscles traction respectively. [Result] The baseline HR was higher in S group [S vs H： （119±23） vs （108±20）, P 〈0.05]. The HR abruptly decreased when ocular muscles were tracted in both group （compared with baseline, P 〈 0.01）, The lowest HR was higher in S group during OCR period IS vs H： （95±13） vs （75±15）, P 〈0.01]; The incidence of anythmias and OCR concomitant with ocular muscle traction occurred were less frequently in S group [arrythmias： S vs H： 4% vs 20%, P 〈0.01; OCR： S vs H： 41% vs 79%, P 〈0.01]. RR reduction occurred accompanied with OCR [S： （32.3±3.0） vs （38.0±2.2）, P 〈0.05, H： （28.0±3.7） vs （34.5± 3.0）, P 〈0.05], but the lowest RR during OCR period was higher in S group than in H group （P 〈 0.01）. [Conclusion] Some children experience OCR and ORR when surgeon pull on ocular muscles during squint operation under inhalation anesthesia. Sevoflurane may reduce incidence of OCR and ORR when compared with halothane, sevoflurane is a better choice of inhalation anesthetic agent for children strabismus surgery.