硬膜外麻醉在小儿腹腔镜手术中的应用研究

The application of epidural anesthesia in laparoscopy of children

目的：探讨硬膜外麻醉用于小儿腹腔镜下腹部手术的可行性、安全性和实用性。方法：选择4～10岁ASAⅠ-Ⅱ级腹腔镜下行阑尾切除、疝囊腹壁内环口高位结扎术患儿60例，随机分为两组。A组30例，常规气管插管氯胺酮复合咪唑安定静脉全麻。B组30例，基础麻醉后行连续硬膜外麻醉，常规紧闭面罩给氧、辅助呼吸；术中连续监测HR、SBP、DBP、SpO2、PETCO2。结果：两组患儿术中安静、麻醉满意、肌松良好。气腹后HR、SBP、DBP、PETCO2均高于气腹前（P〈0．05），但尚在正常范围，组间比较无明显差异（P〉0．05），放气后10min上述参数恢复至气腹前水平。两组SpO2为98％～100％，无差异。苏醒时间A组明显长于B组（P〈0.05）。结论：连续硬膜外麻醉用于手术时间较短的腹腔镜小儿下腹部手术效果确切，对呼吸循环的影响轻，术毕苏醒快，是可行的麻醉方法。

Objective：To study the feasibility, safety and practicability of epidural anesthesia in children＇s lower abdominal surgery by laparoscope. Methods：sixty cases（4-10 years old, ASAⅠ -Ⅱ ）received appendectomy or the inner ring ligation of the hernia by laparoseope were randomly divided into two groups. Group A：30 cases, received ketamine and midazolam intravenons anaesthesia with endotracheal intubation. Group B：30 cases, taken continuous epidural anesthesia after basal anesthesia with assistant respiration by mask and supply of oxygen. The parameters of HR, SBP、 DBP,SpO2 ,PET CO2 were monitored continuously during the operations. Resuits ： All of the patients were quiet during the operations and the relaxation depth of abdominal muscle was good. The effect of anaesthesia was satisfactory. The parameters of HR,SBP,DBP,PETCO2 increased a little after establishing pneumopcritoncum（ P 〈 0.05 ） ,with no significant differences between the two groups, which returned to normal level in 10 minutes after deflation. The SpO2 was in the range from 98% to 100%. The average recovery time of the group A was longer than group B（ P 〈 0.05 ）. Conclusions ： Continuous epidural anesthesia is a feasible and effective method in some children＇s short time lower abdominal surgery by laparoscope. It has satisfactory effect, little influence on breath and circulation, and short recovery time after operation.