非插管下全凭七氟烷吸入用于小儿短小手术的麻醉效果

ANESTHESIA EFFECTS OF SOLELY SEVOFLURANE INHALATION IN CHILDREN MINOR SURGERY UNDER NON -INTUBATION CONDITION

目的探讨非插管条件下单纯吸入七氟烷用于小儿短小手术的可行性与安全性。方法选择ASA Ⅰ级择期行斜疝、鞘膜积液、血管瘤等短小手术的患儿60例,年龄1～8岁,随机分为氯胺酮组(K组)和七氟烷组(S组),各30例。2组术前均给予阿托品0.01～0.02mg/kg肌内注射。K组给予氯胺酮6mg/kg肌内注射,入睡后开放静脉,常规监测,面罩吸氧,术中如有体动,则静脉追加氯胺酮每次1～2mg/kg。S组给予5%七氟烷吸入诱导,氧流量8L/min,以加压面罩吸入,患儿入睡后开放静脉,监测心电图、血压、氧饱和度,以及呼末二氧化碳分压和七氟烷的浓度。术中氧流量调整为1L/min,根据体动、心率和血压等情况调节七氟烷的吸入浓度,使呼出浓度维持在2.5%～3.0%,如呼吸抑制则行面罩机控呼吸。手术结束时停吸七氟烷,氧流量恢复至8L/min,直至自主呼吸平稳,再给予普通面罩吸氧。比较2组的诱导时间和苏醒时间,以及术中心率、血压和氧饱和度的变化。同时观察2组的不良反应。结果 S组的诱导时间和苏醒时间分别短于K组,差异有统计学意义(P<0.01);2组的心率、血压、氧饱和度差异无统计学意义(P>0.05);2组术中均未发生呛咳、喉痉挛、流涎等不良反应;苏醒期,2组呕吐发生率差异无统计学意义(P>0.05),躁动发生率S组高于K组,差异有统计学意义(P<0.01)。结论七氟烷的诱导时间及苏醒时间均较氯胺酮快,而在非插管情况下,全凭七氟烷吸入更适用于小儿短小手术的麻醉。

Objective To investigate the feasibility and safety of solely inhaled sevoflurane in children＇s minor surgery under non - intubated condition. Methods Sixty children who undergoing elective surgery such as indirect hernia , hydrocele of tunica vagina]is and hemangi0ma , with ASA physical status Ⅰ , 1 to 8 years old were recruited and randomly allocated to ketamine group（ group K, n =30） and sevoflurane group （group S, n = 30）. Atropine 0,01 -0.02mg/kg was administered to all patients before surgery via intramuscular route. In group K, Ketamine 6mg/kg was intramuscularly injected, then intravenous route, routine monitoring and oxygen supply were initiated, and Ketamine 1 - 2mg/kg would intravenously administered every time if body movement occurred. In group S, anesthesia induction was conducted by 5% sevoflurane in conjunction with 8L/rain oxygen flow , then intravenous route, routine monitoring and oxygen supply were initiated after patients falling sleep. Oxygen flow was set to 1 L/min during operation. Concentration of inhaled sevoflurane was regulated according to body movement , heart rate and blood pressure. Concentration of end - tidal sevoflurane was maintained between 2.5% and 3.0%. Assisted controlled ventilation was instituted through artificial pressurized mask in the presence of respiratory depression. Oxygen flow was set to 8 L/rain after the completion of surgery. Induction time, recovery time and peri -operative heart rate , blood pressure and oxygen saturation of pulse in both groups were recorded, and side effects were observed. Results Induction time and recovery time in group S were shorter than that in group K, there were significant difference between the two groups（ P 〈0.01 ） ,while there were no significant difference between heart rate ,blood pressure and oxygen saturation of pulse in both groups. Bucking, laryngeal spasm and polysialia were not observed in two groups. During recovery period, there was significant difference about the incidence of restlessness（ P 〈 0.01） ,but not the incidence of vomiting when compared with group K（ P 〉 0.05）. Conclusion Anesthesia induction and recovery by solely inhaled sevoflurane in children＇ s min6r surgery was faster than that via ketamine. Solely inhaled sevoflurane anesthesia was feasible and safe in children＇ s minor surgery under non -intubation condition .