喉罩下七氟醚用于小儿腹股沟斜疝手术的麻醉效果

Sevoflurane anesthesia under laryngeal mask airway for pediatric patients undergoing indirect inguinal hernia hernioplasty

目的比较喉罩下七氟醚吸入麻醉与氯胺酮静脉麻醉在小儿腹股沟斜疝手术中的麻醉效果。方法择期行腹股沟斜疝修补术手的患儿60例,年龄3～9岁,ASAⅠ～Ⅱ级,随机均分为喉罩下七氟醚麻醉组(S组)和氯胺酮麻醉组(K组)。S组给予七氟醚吸入诱导,置入喉罩成功后保留患儿自主呼吸,术中根据手术刺激大小调整七氟醚浓度为3%～4%;K组患儿诱导时静脉注射氯胺酮1mg/kg,术中间断静脉追加氯胺酮0.5～1.0mg/kg维持麻醉。记录麻醉前(T0)、切皮前(T1)、切皮后1min(T2)、30min(T3)、术毕时(T4)MAP与HR;记录两组患儿意识消失、苏醒、清醒时间;观察两组患儿麻醉期间及麻醉后不良反应情况。结果两组术中镇静、镇痛效果良好,差异无统计学意义(P>0.05);与K组比较,S组麻醉诱导后及术中血流动力学变化小,意识消失、苏醒、清醒时间短,麻醉期间及麻醉后不良反应发生率低(P<0.05)。结论喉罩下七氟醚吸入麻醉在小儿腹股沟斜疝手术中优于氯胺酮静脉麻醉。

Objective To compare the anesthetic effect of sevoflurane anesthesia under laryngeal mask airway（LMA） with ketamine for pediatric patients undergoing indirect inguinal hernia hernioplasty.Methods Sixty children aged 3～9 years old with ASA Ⅰ～Ⅱgrads,undergoing indirect inguinal hernia hernioplasty were randomly divided into two groups（n=30）：sevoflurane under LMA group（S group） and ketamine group（K group）.S group was induced with sevoflurane,after laryngeal mask placed successfully,children autonomic breath was retained,concentration of sevoflurane was maintained at 3%～4% according to the extent of surgical stimulation during operation.K group was injected ketamine 1 mg/kg for anesthesia induction,and discontinuously at 0.5～1.0 mg/kg during operation.The values of MAP and HR were recorded at the following time points：before anesthesia（T0）,incision immediate（T1）,1 min（T2） and 30 min（T3） after incision,and completion of operation（T4）.The induction time,recovery or sobriety time,occurrence of limb movement,complication such as respiratory depression,agitation and sickness were recorded.Results The MAP and HR variation of S group was less than that of K group（P0.05）.The induction time and recovery or sobriety time of S group was shorter than that of K group（P0.05）.The incidence of movement during operation and agitation,sickness after operation of S group was less than that of K group（P0.05）.Conclusion Sevoflurane anesthesia under LMA is superior to ketamine in pediatric patients undergoing indirect inguinal hernia hernioplasty.