经喉罩全凭七氟醚吸入全麻在小儿腹腔镜手术中的应用

Application of Total Sevoflurane Inhalation Anesthesia by the Laryngeal Mask in Pediatric Laparoscopic Surgery

目的探讨经喉罩全凭七氟醚吸入全麻在小儿腹腔镜手术中应用的效果及安全性。方法选择60例2～10岁进行腹腔镜择期手术的患儿,随机分为两组,A组为七氟醚组,采用高浓度七氟醚诱导后,置入喉罩全凭七氟醚吸入全麻;B组为氯胺酮组,采用氯胺酮、芬太尼静脉诱导后置入气管插管,术中氯胺酮及丙泊酚维持静脉全麻。连续观察两组患儿术中MAP、SPO2、HR的变化,以及术毕停药以后两组患儿的睁眼时间、定向力恢复、安全离开手术室的时间。结果两组患儿的睁眼时间、定向力恢复、安全离开手术室时间及发生恶心、呕吐、与躁动的现象均存在明显差异(P<0.05),七氟醚组少于氯胺酮组。结论经喉罩全凭七氟醚吸入全麻在小儿腹腔镜手术中时,诱导快,无异味刺激,对循环呼吸影响小,术后麻醉苏醒快,恶心呕吐、口咽不适、躁动发生率低,是应用于小儿麻醉较为理想的方法。

Objective To explore the effect and safety of total sevoflurane inhalation anesthesia by the laryngeal mask in pediatric laparoscopic surgery. Methods 60 cases of 2 to 10-year-old children with laparoscopic surgery were randomly divided into two groups. Group A （sevoflurane group） were inserted with laryngeal mask for inhaled sevoflurane anesthesia after high concentration sevoflurane induction; group B （ketamine＇group） received the trachea cannula for ketamine and propofol intravenous anesthesia after ketamine and fentanyl induction. The changes of mean arterial pressure （MAP）, SPO2, heart rate （HR） during operation and pediatric patients＇ eye-opening time, redirect recovery time, leaving operating room time after operation were observed. Results The complications （including nausea, vomiting and restless） and eye-opening time, redirect recovery time, leaving operating room time in the sevoflurane group were fewer than those in ketamine group, the difference between two groups had statistically significant （P〈0.05）. Conclusions Total sevoflurane inhalation anesthesia by the laryngeal mask in pediatric laparoscopic surgery has the advantages of quick induction and recovery, no smell stimulation, less circulatory system effect and fewer complications （including nausea, vomiting and restless）, which is an ideal method for pediatric anesthesia.