喉罩七氟醚吸入全麻与氯胺酮在小儿包皮环切术中的应用

CONPARISON OF SEVOFLURANE INHALATIONAL WITH LARYNGEAL MASK ANESTHESIA AND KETAMINE INTRAVENOUS ANAESTHESIA IN CHILDREN UNDERTAKING MALE CIRCUMCISION

目的比较两种麻醉方法在小儿包皮环切术中的应用效果,并比较优缺点。方法选择ASAⅠ～Ⅱ级2,～5岁择期行包皮环切术的患儿60例,随机均分为喉罩七氟醚吸入组(S组)和氯胺酮静脉麻醉组(K组),每组30例,两组患儿均保留自主呼吸且切皮前均在阴茎根部予以1%利多卡因充分浸润阻滞。观察患儿术中生命体征,记录睫毛反射消失时间、局麻时肢体活动、血氧饱和度SpO2<95%的发生例数、清醒时间、躁动发生的例数和术后呕吐(Postoperative Vomiting,POV)等指标。结果麻醉前两组患儿血压及心率无统计学差异(p>0.05),麻醉后S组各个时点血压及心率明显低于麻醉前及对应时间点的K组(p<0.05)。S组睫毛反射消失时间、血氧饱得度SpO2<95%的发生例数、术后清醒时间和肢体活动均明显低于K组(p<0.05),但躁动发生的例数和POV无明显差异(p>0.05)。结论在小儿包皮环切术中,两种麻醉方法均安全有效,但喉罩七氟醚吸入全麻起效迅速,血氧饱和度维持好,清醒快而完全,术后躁动发生率低,优于氯胺酮静脉全麻。

Objective To explore the advantages and disadvantages of sevoflurane inhalational anesthesia with laryngeal mask and compare with ketamine intravenous anesthesia in children undertaking male circumcision. Methods Sixty children aged 2～5 years（ASA I～II grade） undertaking male circumcision were randomly divided into sevoflurane inhalational anesthesia with laryngeal mask group（the sevoflurane group,n=30）and ketamine intravenous anesthesia group（the ketamine group,n=30）.All the children breathed spontaneously during operative period and application of the nerve block anesthesia on the penis root with 1% lidocaine before skin incision.To monitor the vital signs during operative period and record the lash reflex extinction time,the movement of the limbs by local anesthesia stimulation,the incidence of SpO2 was less than 95%,the revival time,postoperative restlessness and postoperative vomiting（POV） in all children. Results There was no significant difference in MAP and HR in all the children before anesthesia,but the MAP and HR in group S at various intervals were less than those before anesthesia and at the same time than those in group K（p0.05）.The lash reflex extinction time,the incidence of SpO2 less than 95% and postoperative restlessness and the revival time in group S were less than those in group K（p0.05）.There was no significant difference in the incidence of the movement of the limbs and postoperative vomiting（POV） between the two groups. Conclusion Two anesthesia methods for the male circumcision were safe and effective,but sevoflurane inhalational anesthesia with laryngeal mask acted immediately,kept the SpO2 maintained well,awake more quickly and absolutely,had the low incidence of postoperative restlessness.It is a new anesthesia method with more advantages in children undertaking male circumcision.