国产喉罩静脉全麻复合臂丛阻滞应用于小儿上肢手术效果观察

An effect observation of homemade LMA intravenous general anesthesia combined brachial plexus block for children with upper limb operation

目的观察国产喉罩静脉全麻复合臂丛区域阻滞用于小儿上肢手术的应用效果,为国产喉罩的临床应用提供参考。方法选取40例择期行上肢手术的小儿患者为研究对象,随机分为喉罩静脉全麻复合臂丛阻滞组(L1组),氯胺酮静脉麻醉复合臂丛阻滞组(L2组),每组20例。L1组应用芬太尼0.2ug/kg,异丙酚2.5mg/kg,根据体重选择国产喉罩型号,置入喉罩并保持自主呼吸通气,静脉输注异丙酚4mg/(kg·h),L2组氯胺酮2mg/kg静脉注射,静脉输注氯胺酮1mg/(kg·h)。比较两组麻醉效果、苏醒时间、并发症及术后躁动情况。结果两组手术时间比较无统计学差异(t=0.774,P>0.05),在切皮、缝皮及苏醒时L2组在HR、Sp O2、RR等生命体征指标波动较L1组波动较大,差异有统计学意义(P<0.05),L1组平均苏醒时间(12.6±4.8)min,L2组平均苏醒时间(20.8±6.6)min,L1组苏醒时间短于L2组(t=7.163,P<0.05)。L1组在切皮、缝皮及苏醒时镇静效果Ramsay评分高于L2组(P<0.05),L1组术后躁动发生率为5.0%,L2组术后躁动发生率为25.0%,L1组术后躁动发生率低于L2组(x2=3.137,P<0.05),L1组咽喉部并发症与L2组无统计学差异(x2=1.026,P>0.05)。结论国产喉罩静脉全麻复合臂丛区域阻滞用于小儿上肢手术镇静效果良好,术中麻醉平稳,苏醒期较短,术后并发症较少,安全性高,值得临床推广应用。

Objective To observe the effect of homemade LMA intravenous general anesthesia combined brachial plexus block for children with upper limb operation, thus to provide a reference for clinical application of homemade LMA. Methods 40 pediatric patients who were undergoing upper limb operation were selected as the research object, they were randomly divided into the LMA intravenous general anesthesia compound group of brachial plexus block group （Group L1）, and the ketamine intravenous anesthesia combined with brachial plexus block anesthesia group （Group L2）, 20 cases in each group. Fentanyl 0.2ug/kg and propofol 2.5mg/kg were applied in group L1, the homemade LMA types were chose by the weight, LMA and maintain autonomous breathing ventilation, intravenous infusion of propofol in group L2 2mg/kg 4mg/（kg·h）, ketamine intravenous injection, intravenous infusion of ketamine 1mg/（kg·h）. Make a comparison of two groups of anesthesia effect, recovery time, complications and postoperative restlessness. Results No significant differences between the two groups of operation time （t=0.774, P 〉 0.05）, at skin incision, suture of skin and wake up in group L2, HR, SpO2, RR and other vital signs index fluctuations larger fluctuation than that in L1 group, the difference was statistically significant （P 〈 0.05）, the average recovery time of group L1 （12.6 ＋ 4.8） min, L2 group the average recovery time （20.8＋ 6.6） min, L1 group recovery time shorter in the L2 group （t=7.163, P 〈 0.05）. In group L1, skin incision, suture of skin and awakens the sedative effect of Ramsay was higher than that of L2 group （P 〈 0.05）, in L1 group the postoperative agitation rate was 5%, L2 group the postoperative agitation rate was 25%, L1 group the postoperative agitation rate lower than that of group L2 （x2=3.137, P 〈 0.05）, the L1 group complications of throat and L2 group showed no significant difference （x2=1.026, P 〉 0.05）. Conclusion Intravenous general anesthesia combined with brachial plexus block area of domestic laryngeal mask for children with upper limb operation excellent sedative effect, intraoperative anesthesia was stable, the recovery period is shorter, less postoperative complications, high security, is worthy of clinical application.