七氟醚低流量满刻度洗入紧闭麻醉法在小儿手术中的应用

Sevoflurane wash-in in low-flow with full scale and maintenance of anesthesia with closed-circuit in children

目的探讨七氟醚低流量满刻度洗入、低流量洗出紧闭麻醉法用于小儿手术的可行性。方法选择耳鼻喉、口腔及眼科择期短小手术患儿90例,2～14岁,ASAⅠ或Ⅱ级,静脉快速诱导后气管内插管,随机均分为三组,分别以0.3L/min(0.3组)、0.6L/min(0.6组)和1.0L/min(1.0组)的氧流量满刻度洗入,肺泡气七氟醚浓度(FAsev)达到1.3MAC后蒸发器刻度改为3%～8%,0.2～0.3L/min氧流量维持。在手术结束前12min关闭蒸发器,以0.3L/min的氧流量洗出;手术结束时以5L/min的氧流量快速洗出。结果各组麻醉期间的血流动力学稳定,术中术后各组均未见并发症。0.3组的维持期耗药量[(1.54±0.70)ml]明显少于1.0组[(2.14±1.10)ml](P<0.05),0.3组的洗入时间[(10.23±4.22)min]明显长于0.6组[(4.17±1.02)min]和1.0组[(2.70±0.88)min](P<0.05)。结论七氟醚低流量满刻度洗入、低流量洗出紧闭麻醉法用于小儿手术安全、有效、可行,可更大程度的节约麻醉药、减少对环境的污染,并能解决低流量麻醉早期不能向环路释放足够麻醉药这一问题。

Objective To evaluate whether sevoflurane wash-in in low-flow with full scale, wash-out in low-flow and maintenance of anesthesia with closed-circuit would be feasible in children. Methods Ninety children （2-14 years old, ASA class I or Ⅱ ） scheduled for surgery on ear, nose, throat, oral cavity or eye were enrolled. After induction with intravenous anesthetics and tracheal intuhation, the patients were randomly assigned to wash-in in 0.3 L/min （group 0.3）, 0.6 L/min （group 0.6）, 1.0 L/min （group 1.0） and in full-scale. When the alveolar concentration of sevoflurane reached 1.3 MAC, the scale of the vaporizer was changed to 3%-8% and the oxygen flow was maintained at 0.2-0.3 L/min. The vaporizer was turned off at 12 min before the end of operation, and sevoflurane was washed-out in the oxygen flow of 0.3 L/min. When the operation completed, sevoflurane was washed-out in the oxygen flow of 5 L/min. Results No significant changes occurred in BP and HR in all groups. The expenditure of sevoflurane of group 0.3 during the maintenance [（1.54±0.70） ml ] was less than that of group 1.0 [（2.14±1.10） ml]（P〈0.05）. The time of wash-in of group 0.3[（10.23±4.22） mini was longer than that of group 0.6 [（4. 17±1.02 ） min] and group 1.0 [（2.70 ± 0.88） mini （P〈 0.05）. Conclusion Inhalation anesthesia of sevoflurane wash-in in low-flow with full scale, wash-out in low-flow and maintenance of anesthesia with closed- circuit in children is safe, effective and feasible with less anesthetic consumption.