第三代喉罩七氟醚吸入麻醉在小儿骨科手术中的应用观察

The Application Observation of Pro-seal Laryngeal Mask Airway with Sevoflurane Anesthesia in Pediatric Orthopedics Operation

目的：观察第三代喉罩七氟醚吸入麻醉在小儿骨科手术中的麻醉效果和不良反应。方法：纳入188例行骨科手术治疗患儿,按照随机数字表法分为观察组和对照组,各94例。于麻醉前30 min给予盐酸戊乙奎醚注射液0.02 mg/kg静脉推注。面罩吸氧,氧流量6 L/min,采用潮气量法8%七氟醚快速吸入诱导。待睫毛反射消失,下颌松弛后,对照组置入气管导管,观察组置入喉罩。依次以0.3 mg/kg依托咪酯、0.2 mg/kg顺式阿曲库铵静脉注射。术中监测收缩压、舒张压、潮气量、呼气末二氧化碳分压,将呼气末二氧化碳分压维持在35-45 mm Hg,保持七氟醚浓度2%-3%,调节氧浓度1-2 L/min,并以瑞芬太尼0.1μg/（kg·min）持续静脉泵入维持麻醉。记录术中平均动脉压（MAP）、心率（HR）、脉搏氧饱和度（Sp O2）变化;并观察不良反应。结果：2组患儿MAP比较,在术毕能唤醒时及拔管后均较诱导前和插管时有所升高,差异有统计学意义（P〈0.05）;观察组HR在拔管后较诱导前、插管时及术毕能唤醒时有所升高,差异有统计学意义（P〈0.05）;对照组HR在插管时、术毕能唤醒时、拔管后较诱导前有所升高,差异有统计学意义（P〈0.05）。观察组在术毕能唤醒时、拔管后MAP指标低于对照组,差异有统计学意义（P〈0.05）;观察组在插管时、术毕能唤醒时、拔管后HR指标低于对照组,差异有统计学意义（P〈0.05）。2组患儿麻醉前后Sp O2变化不大,差异无统计学意义（P〉0.05）。观察组不良反应少于对照组（P〈0.05）。结论：小儿骨科手术应用第三代喉罩七氟醚吸入麻醉,麻醉效果满意,安全可靠,不良反应少。

Objective： To observe the anesthesia effect and adverse reaction of pro-seal laryngeal mask airway with sevoflurane anesthesia in pediatrics orthopedics operation. Methods： A total of 188 children with orthopedics operation were randomly divided into observation group and control group. Before 30 minuters,all cases received intravenous injections of penehyclidine hydrochloride of0. 02 mg / kg and mask oxygen（ oxygen flow rate 6 L / min）,and 8% sevoflurane rapid inhalation induction. Until loss of eyelash reflex,jaw relaxation,the control group used tracheal catheter,the observation group used laryngeal mask,followed by intravenous injection of 0. 3 mg / kg etomidate,0. 2 mg / kg atracurium. Systolic blood pressure,diastolic blood pressure,tital volume was monitored. The Pet CO2 was maintained at 35-45 mm Hg,keep 2%-3% sevoflurane,regulating oxygen 1-2 L / min,and remifentanil 0. 1μg /（ kg·min） continuous intravenous pumping to maintain anesthesia. Mean arterial pressure,heart rate and Sp O2 was recorded and adverse reactions was observed. Results： Mean arterial pressure in postoperative awaken and after extubation were higher than that before induction and intubation in 2 groups（ P〈0. 05）. Heart rate in the observation group after extubation were higher than that before induction,intubation and postoperative awaken time,the difference was statistically significant（ P〈0. 05）. HR in control group at the time of intubation,postoperative awake time,after extubation were higher than that before induction,the difference was statistically significant（ P〈0. 05）. In the observation group,MAP in postoperative awaken time and after extubation was lower than that in the control group,the difference was statistically significant（ P〈0. 05）. In the observation group,HR at the time of intubation postoperative awaken time,after extubation was lower than that in the control group,the difference was statistically significant（ P〈0. 05）. Before and after anesthesia,there was no significant difference in Sp O2（ P〈0. 05）. There was significant significance in adverse reaction between 2 groups（ P〈0. 05）. Conclusion： Pro-seal laryngeal mask airway with sevoflurane anesthesia in pediatric orthopedics operation is satisfactory,safe and reliable,has less adverse reaction.