三种非气管内插管全麻在学龄前儿童腹股沟斜疝手术中的应用比较

Applicative comparison of three kinds of non-intubation general anesthesia in pre-school children's surgery

目的将三种非气管插管全麻应用于学龄前儿童腹股沟斜疝手术并进行对比分析,从而探讨更适合学龄前儿童的麻醉方法。方法 75例腹股沟斜疝患儿,ASAⅠ-Ⅱ级,年龄3-6岁,择期行腹股沟斜疝高位结扎术,随机分为氯胺酮-丙泊酚全麻组（A组）、喉罩-七氟烷全麻组（B组）和面罩下静吸复合全麻组（C组）。记录麻醉期间不同时点的平均动脉压（MAP）、心率（HR）、呼气末二氧化碳分压（PETCO2）、脉搏血氧饱和度（Sp O2）,并记录置入喉罩或鼻咽通气道的时间和一次成功率,患儿清醒时间和离开手术室的时间以及出现不良反应的患儿例数。结果 A组患儿麻醉后各时点MAP、HR明显高于麻醉前及对应时点B、C两组患儿（P〈0.05）,置入、拔出喉罩或鼻咽通气道时B组患儿MAP、HR明显高于C组患儿（P〈0.05）,三组患儿麻醉后PETCO2均高于麻醉前,A组患儿一直维持相对较高水平,而B、C两组患儿逐渐降低恢复至麻醉前水平。置入鼻咽通道的时间明显短于置入喉罩的时间（P〈0.05）,一次性置入鼻咽通道的成功率也明显高于一次性置入喉罩的成功率（P〈0.05）,B、C两组患儿清醒时间和出室时间均明显短于A组（P〈0.05）,而B、C两组间比较无统计学差异（P〉0.05）,C组不良反应发生率明显少于A、B两组（P〈0.05）。结论面罩下非气管内插管静吸复合全麻能保持呼吸道的通畅,具有操作简单、对全身影响小、麻醉平稳、苏醒快、不良反应发生率低等优点,值得临床推广应用。

Objective To apply and compare three kinds of non-intubation general anesthesia in pre-school children＇s surgery,so as to find out a more suitable anesthesia for them. Methods A total of 75 children with indirect inguinal hernia（ ASA Ⅰ- Ⅱ,aged 3- 6 years） undergoing high ligation were randomly divided into ketamine-propofol group（ Group A）,laryngeal mask airway（ LMA）-sevoflurane group（ Group B） and intravenation-inhalation（ under mask） combined anesthesia（ Group C）. Such parameters,as MAP,HR,PETCO2,Sp PO2,and so on,were recorded. Results The MAP and HR at every time point after anesthesia in Group A was obviously higher than that before anesthesia,and that at the counterpart time point in Group B and C（ P〈0. 05）,and the MAP and HR during inserting and pulling out LMA or nasopharyngeal airway in Group B was higher than that in Group C（ P〈0. 05）. PETCO2 was higher after anesthesia than before anesthesia in the three groups,but the PETCO2 in Group A kept a higher level for long,and that in Group B and C kept decreasing to the level before anesthesia. The time to insert nasopharyngeal airway was shorter than that to insert LMA（ P〈0. 05）,and the first-time success rate of inserting nasopharyngeal airway was higher than that of inserting LMA（ P〈0. 05）. The waking time and the leaving operation room time of Group B and C were earlier than that of Group A（ P〈0. 05）,but between Group B and C there were no obvious difference（ P〉0. 05）. Adverse reactions were obviously less in Group C than in Group A and B（ P〈0. 05）. Conclusion Non-intubation inhalation and intravenous anesthesia under the mask can maintain respiratory tract unobstructed during and after operation in pre-school children＇s surgery. It can be operated easily,and has little influence on the children.