不同呼气末七氟醚浓度下拔管期婴幼儿气道反应的比较

Airway complication during extubation period under different end-tidal alveolar concentration of sevoflurane in pediatrics

目的 探讨2岁以下婴幼儿唇腭裂手术后不同呼气末七氟醚浓度（CET Sev）下拔管的安全性与有效性.方法 选择2012年6～11月,4月至2岁择期先天性唇腭裂修补术的患儿60例.随机均分为三组：A组（CET Sev：0.70％～0.60％）、B组（CET Sev：0.59％～0.50％）和C组（CETSev≤0.49％）.各组患儿均以七氟醚面罩诱导（8％,6 L/min）入睡后,常规诱导行气管插管.术中以2％～3％七氟醚维持麻醉深度.A组和B组停止吸入麻醉药后,恢复足够的自主呼吸（VT 6ml/kg,PETCO235～45 mm Hg）.C组的拔管指征：脸部肌肉活动,自主睁眼,且目的性的手部运动.研究对象在拔管后用面罩吸入氧气（100％,3 L/min）.在停药至拔管后10 min,所有呼吸系统的并发症均被记录,如：咳嗽、呼吸抑制、喉痉挛、缺氧、分泌物过多（拔管后仍需要吸引）、咬管和呕吐等.同时记录自主呼吸恢复时间和拔管时间等.结果 共有12例（20％）发生不同程度的气道并发症事件：C组术后气道分泌物过多、喉痉挛、低氧血症、咳嗽和再次气管插管等术后气道并发症的发生率为6例（30％）,明显高于A组的2例（10％）、B组的4例（20％）（P＜0.05）.三组间自主呼吸恢复时间与拔管时间差异无统计学意义.结论 2岁以下的患儿行唇腭裂修补手术,在保证呼吸道清洁和通畅的情况下,一定的麻醉深度更有利于减少拔管继发的呼吸道并发症,而且未延长自主呼吸恢复时间和拔管时间.

Objective To observe the safety and efficacy of extubation under different end-tital sevoflurane （CETSev） in pediatrics undergoing cleft lip palate surgery.Methods Sixty children under 2 y scheduled for cleft lip palate surgery were randomly allocated into three groups,group A （CETSev：0.70-0.60％）,group B（CETSev：0.59-0.50％）and group C（CETSev≤0.49％）.Every patient was inducted with sevoflurane （8％,6 L/min） until loss of conscious and then was trachea intubated.Anesthesia depth was maintained by inhaling sevoflurane （2％-3％）.After weaning from sevoflurane and spontaneous respiration was obtained,patients in group A and group B were extubated at the time of （CETSev：0.70-0.60％）and （CETSev..0.59-0.50％）individually.While extubation was carried out in group C at the time of CE-T Sev below 0.49,after facial,eye and body movement were observed.Oxygen was applied with mask（100％,3L/min）.All the complications were recorded within 10min after extubation such as cough,breath holding,laryngospasm,hypoxemia and hypersecretion,et al.Recovery time from drug withdrawal to spontaneous respiration and to extubation were recorded.Results Patients of 12 （20％） were suffered from different airway complications during extubation period.Patient of 6 （30 ％） suffered excessive airway secretions,laryngospasm,hypoxemia,cough and again after endotracheal intubation in group C,were higher than that in group A of 2（10％） and in group Bof 4 （20％）.The recovery time showed no significantly difference among all three groups.Conclusion During cleft lip palate surgery in pediatric patients below 2yr,sufficient anesthesia depth in a certain degree is beneficial for extubation to avoid some respiratory complications without interfering the recovery time.