不同麻醉方法在唇腭裂修复手术中的应用比较

Comparison of Different Anesthesia Methods in Repair of Cleft Lip and Palate

目的比较分析不同的麻醉方法在唇腭裂修复手术中的应用,探讨唇腭裂修复手术理想的麻醉方法。方法将108例不同时期的婴幼儿唇腭裂修复手术,按麻醉方法分为氯胺酮静脉麻醉组(K组)52例和七氟醚吸入全麻组(S组)56例。K组,氯胺酮20μg/(kg.min)持续静脉泵注;S组,2～3vol%七氟醚持续吸入,保留自主呼吸。观察比较麻醉期间心率(HR)和脉搏血氧饱和度(SPO2)的变化以及麻醉相关不良反应的发生情况。结果两组间HR比较,术前、术中、术后均有显著差异;同组内HR比较,K组术中明显高于术前,而S组无明显变化。两组间SPO2比较,术前差异有统计学意义(P<0.01),术中和术后无差别(P>0.05);而两组内术中与术前比较差异均有统计学意义(P<0.01)。围术期喉痉挛、低氧、躁动和恶心呕吐等不良反应,组间比较无差别(P>0.05)。结论七氟醚气管插管吸入麻醉是婴幼儿唇腭裂修复手术较为理想的麻醉方法。

Objective To explore an ideal anesthesia method in cleft lip and palate surgery by comparing the effects of different methods.Methods 108 cases of cleft lip and palate surgery at different stages were divided into Ketamine intravenous anesthesia group[（K group,n=52,received Ketamine 20 μg/（kg·min） continuous intravenous infusion）] and Sevoflurane inhalation anesthesia group（S group,n=56,received 2 to 3% v/v of Sevoflurane continuous inhalation and retained spontaneously breathing）.The heart rate（HR）,SPO2 and incidence of adverse effect related to anesthesia were observed.Results The difference in HR was significant between the two groups before,during and after the operation.The intraoperative level of HR was significantly higher than preoperation level in group K,while not in group S.The obvious difference of SPO2 was showed between the two groups before the operation（P0.01）,but not duration and after the operation（P0.05）.The difference of SPO2 before operation and during operation had statistical significance（P0.01） both in the group K and in group S.The perioperative adverse reactions such as laryngeal spasm,hypoxia,restlessness,nausea and vomiting had not statistical difference between both groups（P0.05）.Conclusion Sevoflurane inhalation anesthesia by endotracheal intubation is a satisfactory anesthesia method for infants with cleft lip and palate surgery.