丙泊酚靶控输注联合低浓度七氟烷诱导在婴幼儿气管异物取出术中的应用

Propofol target controlled infusion plus a low concentration of sevoflurane inhalation inductionanesthesia for the removal of foreign body from trachobronchus in children

目的探讨丙泊酚靶控输注（TCI-P）联合低浓度七氟烷吸入诱导麻醉应用于小儿气管支气管异物取出术的疗效。方法2009年1月至2011年5月浙江温州医学院附属第二医院经确诊为气管异物的急诊患儿90例，年龄9-36个月，体质量8—17kg，经医院伦理委员会批准，数字随机法分为A组、B组和C组，每组30例。A组为TCI-P联合低浓度七氟烷吸人诱导；B组为TCI．P复合氯胺酮诱导；C组为TCI-P复合芬太尼诱导；3组患儿术中均采用单纯TCI-P维持麻醉，观察3组的麻醉效果、并发症和患儿在手术室滞留时间及苏醒时间。结果在硬支气管镜置入过程3组均存在一定程度的呛咳，其中发生重度屏气、呛咳需加深麻醉的病例A组为1例、B组7例、C组5例，A组明显优于B组（P〈0．05），但与C组比较差异无统计学意义（P〉0．05）。B组、C组患儿置镜时丙泊酚靶浓度均明显高于A组（P〈0．01），且术中最低SpO：明显低于A组（P〈0．01），术中Sp0：〈95％例数亦明显多于A组（P〈0．01）。B组术毕喉鸣或舌后坠致呼吸困难发生数明显多于A组与C组（P〈0．05），且患儿术毕在手术室滞留时间、苏醒时间明显长于A组与C组（P〈0．01）。结论丙泊酚靶控输注联合低浓度七氟烷吸入麻醉是一种可控性强、安全、实用的婴幼儿支气管异物取出术的麻醉方法。

Objective To explore the effects of propofol target controlled infusion （TCI） plus a low concentration of sevoflurane inhalation induction for the removal of traeheobronchial foreign body in children. Methods After the approval of the hospital ethics committee, a total of 90 patients, aged 9 - 36 months old and weighted 8 - 17 kg, were randomly divided into 3 groups： group A, group B and group C. Propofol TCI plus a low concentration of sevoflurane inhalation induction was administered in group A while ketamine or fentanil plus propofol TCI in group B or C respectively. Effects of anesthesia, complications and recovery durations were observed. Results The incidence of severe breathholding and bucking during inserting bronchoscope was 1 case in group A, 7 in group B and 5 in group C. There were significant differences between groups A and B（ P 〈 0. 05 ）. The minimal intra-operative SpO2 in group B or group C was lower than that in group A （P 〈 O. 01 ）. The cases for intra-operative SpO2 〈 95 % in group B or group C were more than that in group A（ P 〈 0. 01 ）. And the maximal target concentration of propofol was significantly higher than that in group A （ P 〈 0. 01 ）. Ten cases in group B had laryngeal stridor and dyspnea during inspirations post-operatively and occurred more frequently than those in group A or C （ P 〈 0.01 ）. As compared with group A and C, post-operative staying lengths and recovery durations were significantly longer in those in group B （ P 〈 0. O1 ）. Conclusion Propofol TCI plus a low concentration of sevoflurane inhalation induction is both safe and practical for the controlled removal of tracheobronchial foreign body in children.