小儿先天性心脏病介入术中应用非插管全麻联合骶麻的安全性和有效性观察

Exploratory and effective role non-intubation general anesthesia combined with caudal block anesthesia plays in interventional therapy for children with congenital heart disease

目的探讨非插管全麻联合骶麻在小儿先天性心脏病(先心病)介入术中应用的安全性和有效性。方法 60例先心病介入治疗患儿分成非插管全麻加骶管阻滞(I组)和插管静脉麻醉(II组)各30例。在手术开始前、手术开始5、10、30、60 min,手术结束时,苏醒时和回病房时各时间点监测记录血压(BP)、心电图、脉搏血氧饱合度(SpO2)、呼气末二氧化碳分压(PETCO2)、心率(HR)、呼吸状态和次数。术后恶心呕吐采用视觉模拟评分法(VAS)评估。结果全麻药的用量,II组比I组明显增多[咪唑安定:(1.30±0.30)mg vs(0.78±0.28)mg,芬太尼:(76.10±24.61)μg vs(61.33±24.67)μg,丙泊酚:(402.33±78.59)mg vs(206.00±60.90)mg,P<0.05)];I组较II组苏醒时间短[(10.13±3.95)min vs(35.17±4.47)min,P<0.05)],手术后呕吐疼痛发生率低(6.67%vs 16.67%,P<0.05),面部表情疼痛评分低[(2.20±1.77)分vs(5.26±1.11)分,P<0.05]。结论非插管全麻联合骶麻用于小儿先心病介入治疗较插管静脉麻醉费用少,生命体征平稳,麻醉并发症少,值得推广。

To investigate the safety and efficacy of non-tracheal intubation general anesthesia combined with caudal block anesthesia in intervention surgery for children with congenital heart disease. Sixty patients with congenital heart disease underwent intervention surgery were randomized to group I receiving non-intubation general anesthesia combined with caudal block or group II undergoing intravenous anesthesia with intubation.Blood pressure（BP）,pulse oxygen saturation（SpO2）,partial pressure of carbon dioxide in endexpiratory gas（PETCO2）,hear rate（HR）,and the status and frequency of respiration were monitored and recorded before surgery,5,10,30 and 60 min after the beginning of surgery,at the end of surgery,when patients woke up from anesthesia and when they returned to their wards.The visual analogue scales（VAS）was used to evaluate nausea and vomiting. The dosage of intravenous anesthetics in group II was significantly higher than that in group I[Midazolam：（1.30 ± 0.30）mg vs（0.78 ± 0.28）mg,Fentanyl：（76.10 ± 24.61）μg vs（61.33 ± 24.67）μg,Propofol：（402.33 ± 78.59）mg vs（206.00 ± 60.90）mg,P 0.05].Compared with patients in group II,those in group I spent shorter time in waking up from anesthesia[（10.13±3.95）min vs（35.17 ± 4.47）min,P 0.05],and had lower incidence of postoperative vomiting and pain（6.67%vs 16.67%,P 0.05）and lower scores of pain judged by facial expression（2.20 ± 1.77 vs 5.26 ± 1.11,P 0.05）. The non-intubation general anesthesia combined with caudal block anesthesia can lead to steady vital sign and fewer complications of anesthesia in interventional surgery for children with congenital heart disease,furthermore it is less expensive.