骶管阻滞复合喉罩通气用于婴幼儿下腹及会阴部手术的观察

The observation of caudal anesthesia combined with laryngeal mask airway for infants in the lower abdomen and perineum efficacy and safety of surgery

目的探讨骶管麻醉复合喉罩通气用于婴幼儿下腹及会阴部手术的有效性与安全性。方法 60例拟进行下腹会阴部手术的患儿,随机分为骶管阻滞复合喉罩通气组(A组)与氯胺酮麻醉组(B组),A组先行骶管阻滞,成功后静注咪唑安定0.1mg/kg、芬太尼2ug/kg、丙泊酚2mg/kg,根据患儿体重置入相应大小的喉罩,术中持续静脉泵入异丙酚4-6mg/(kg·h)维持,B组静注咪唑安定0.1mg/kg、氯胺酮2mg/kg,10-15min后或术中有体动时追加氯胺酮1-1.5mg/kg,观察两组麻醉诱导前(基础值)、诱导后、切皮时、术中、术毕时的MAP、HR、SPO2。纪录麻醉苏醒时间、术中肌松、体动及苏醒期不良反应等情况。结果两组患儿诱导后HR均明显下降(P<0.05),两组间无明星差异;A组切皮时及术中MAP、HR平稳,B组较基础值明显增高,两组间有显著性差异(P<0.05);A组术中SPO2始终维持在100%。B组患儿有7例术中SPO2下降至95%以下,两组差异显著(P<0.01);肌松优良率A组明显高于B组(P<0.05);苏醒时间A组明显短于B组(P<0.05);术中体动、苏醒期躁动、恶心呕吐发生率A组明显少于B组。结论骶管麻醉复合喉罩通气技术能为婴幼儿下腹及会阴部手术提供满意的镇痛、肌松及理想的镇静深度,术中呼吸循环稳定,术后苏醒快,不良反应少。

【Objective】Discussion of caudal anesthesia combined with laryngeal mask airway for infants in the lower abdomen and perineum efficacy and safety of surgery.【Methods】60 cases of the proposed abdominal perineal surgery were divided randomly into caudal block combined with laryngeal mask airway group,which is the A group,and ketamine anesthesia group,which is the B group,A group of first sacral block,after the success of midazolam 0.1mg/kg,fentanyl 2ug/kg,propofol 2mg/kg in accordance with the body weight in children placed in the appropriate size of laryngeal mask,continuous intravenous pump surgery into propofol 4-6mg /（kg/h） to maintain,B group midazolam 0.1mg/kg,ketamine 2mg/kg,10-15min or after surgery when there is body movement,an additional ketamine 1-1.5mg/kg were observed before induction of anesthesia（baseline）.After induction,skin incision,the surgery,of surgery when the MAP,HR,SPO2,it can record the anesthesia time,intraoperative muscle relaxation,body movement and the emergence of adverse reactions.【Results】Two groups of patients showed a significant decrement after the induction of HR（P〈 0.05）,there is no distinct differences between the two groups;During A group＇s skin incision and intraoperative,the indication of MAP and HR are stable;meanwhile,B group showed a significantly higher compared to the initial baseline.Also,there are significant differences between the two groups（P〈 0.05） ;A group SPO2 surgery was maintained at 100% while in B group,there are 7 cases of children＇s SPO2 dropped to below 95%,thus,there is a significant difference between A and B group（P〈 0.01） ;muscle relaxant rate of A group was significantly higher than B group（P〈 0.05） ;and A group has a significantly shorter recovery time compared B group（P〈 0.05） ;During intraoperative,body movement,agitation,nausea and vomiting occurred significantly less in A group compared to B group.【Conclusion】The combination of caudal anesthesia and laryngeal mask ventilation technique for infants during abdominal and perineal surgery provided satisfactory analgesia,muscle relaxation and the ideal depth of sedation.During intraoperative,respiratory and circulatory are stable,there is a rapid postoperative recovery with low adverse reactions.