七氟醚吸入全麻复合眶下神经阻滞在婴幼儿唇腭裂手术中的应用

Sevoflurane inhalation anesthesia combined with infraorbital nerve block in infant for cleft lip and palate repair surgery

目的探讨七氟醚吸入全麻复合眶下神经阻滞用于婴幼儿唇腭裂修复术的安全性和可行性。方法60例择期行唇腭裂修补术的患儿随机分为两组,每组30例。A组:七氟醚吸入全麻复合眶下神经阻滞;B组:丙泊酚复合氯胺酮麻醉。比较两组血流动力学变化,停药后拔管时间,苏醒时间及术后并发症。结果B组之间T1、T2、T3时点的心率(HR)、平均动脉压(MAP)明显高于A组(P<0.05)。停药到拔管时间、术后清醒时间A组比B组明显缩短(P<0.01)。术中B组平均追加氯胺酮2-3次以维持麻醉,A组未追加其它镇痛药物。B组拔管后有轻中度呼吸道梗阻及恶心、呕吐、躁动不安,而A组无上述并发症。结论七氟醚吸入全麻复合眶下神经阻滞在婴幼儿唇腭裂修复手术中安全、有效,明显缩短患儿苏醒时间,术后并发症少,较全凭静脉麻醉优势明显。

Objective To investigate the safety and feasibility of sevoflurane inhalation anesthesia combined with infraorbital, nerve block for cleft lip and palate repair surgery in infants. Methods Sixty neonates and pediatric patients were studied and randomly divided into two groups （ n = 30）. Group A was treated with sevoflurane inhalation anesthesia combined with infraorbital nerve block, and Group B was treated with propofol combined with ketamine anesthesia. MAP, HR, extubation time after withdrawal, awaking time and postoperative complications were compared in each period anesthesia. Results HR, MAP at T1, T2, T3 in Group B were significantly higher than those in Group A （ P 〈 0.05）. The extubation time and postoperative waking time at Group A were significantly shorter than those in Grou B （ P 〈 0.01 ）. Ketamine was usually added 2 or 3 times to maintain anesthesia in Group B, while other analgesic drugs were no appended in Group A. Airway obstruction, nausea, vomiting, irri- tability occurred in Group B after extubation, while Group A did not. Conclusion Sevoflurane inhalation anesthesia combined with infraorbital nerve block is safe and effective in infant for cleft lip and palate repair surgery.