保留自主呼吸全身麻醉用于小儿唇裂手术的安全性探讨

Monitoring ETCO_2 of the infants undergoing cleft lip repair under general anesthesia with autonomous respiration

目的:评价气管插管保留自主呼吸全身麻醉用于小儿唇裂手术的安全性。方法:唇裂手术小儿40例,随机分为自主呼吸组(A组)和控制呼吸组(C组)2组,A组采用气管插管保留自主呼吸全身麻醉,C组采用气管插管控制呼吸全身麻醉。记录所有患儿入室时(T_0、氯胺酮肌注后10min(T_1)、气管插管后5min(T_2)、气管插管后10min(T_3)、手术结束时(T_4)以及气管拔管后5min(T_5)的心率、脉搏氧饱和度(SpO_2)、呼气末二氧化碳分压(P_(ET)CO_2),以及A组患儿的呼吸频率。应用SPSS11.5软件包进行数据处理,组间比较采用t检验。结果:A组患儿在T_2、T_3、T_4时段P_(ET)CO_2显著高于T_0(P<0.05),且与C组比较差异显著(P<0.05),70%的患儿术中ETCO_2超出正常范围;2组患儿SpO_2术中均维持于正常水平,且2组比较无显著差异(P>0.05);A组患儿呼吸频率在T_2、T_3时段出现显著下降,显著低于T_0时段;2组患儿术中心率平稳,各时段比较无显著差异(P>0.05)。结论:气管插管保留自主呼吸全身麻醉可以用于小儿唇裂手术,但应同时监测ETCO_2和SpO_2,必要时给予辅助呼吸。

PURPOSE： To elevate the security of general anesthesia with autonomous respiration applied for infant cleft lip repair in infants. METHODS： 40 infants who received cleft lip repair were divided into two groups randomly, the autonomous respiration group （group A） and control respiration group （group C）. The infants in group A underwent general anesthesia with autonomous respiration, while the infants in group C underwent general anesthesia with control respiration. The HR, SpOa and PETCOa2 of the infants in two groups, and the breathing rate of the infants in group A on entering operating room （To）, 5 minutes after intramuscular injection of ketamine （T1）, 5 minutes after inserting tracheal catheter （T2）, 10 minutes after inserting tracheal catheter （T3）, at the end of operation （T4） and 5 minutes after removing tracheal eatheter（T5）. SPSS11.5 software package was used to analyze data, and Student＇s t test was used for comparison between the two groups. RESULTS： The PETCO2 of the infants in group A on T2, T3 and T4 was significantly higher than that on To, and higher than that of the infants in group C （P〈0.05）. 70% infants in group A had paranormal ETCOa during operation. The SpO2 of infants in the two groups was normal during operation, and there was no significant different between the two groups. The breathing rate of the infants in group A declined significantly on T2 and T3, and significantly lower than that on To （P〈0.05）. The HR of the infants in the two groups was smooth during operation. CONCLUSION： General anesthesia with autonomous respiration could be used for cleft lip repair in infants, but it was imperative to monitor ETCOa and SpO2, and we should assist the infants to breath if needed.