P SV用于七氟醚麻醉下婴儿腹腔镜疝修补术的效果

Efficacy of pressure support ventilation in infants undergoing laparoscopic hernia repair under sevoflurane anesthesia

目的：评价压力支持通气（ PSV）用于七氟醚麻醉下婴儿腹腔镜疝修补术的效果。方法择期行腹腔镜疝修补术患儿30例，年龄9个月～1岁，性别不限，体重8．0～11．5 kg，ASA分级Ⅰ级。采用随机数字表法，将患儿分为3组（ n＝10）：压力控制通气（ PCV）用于肌松药复合低浓度七氟醚麻醉组（ PCV1组）、PCV用于高浓度七氟醚麻醉组（ PCV2组）和 PSV 用于低浓度七氟醚麻醉组（PSV组）。麻醉诱导：吸入4％～6％七氟醚，静脉注射芬太尼2μg∕kg和琥珀胆碱1．5 mg∕kg，气管插管后行机械通气。 PCV1组和PCV2组采用PCV模式；PSV组无自主呼吸时采用PCV模式，有自主呼吸时采用PSV模式。麻醉维持：PCV1组维持七氟醚呼气末浓度2．5％～3．0％，间断静脉注射顺苯磺酸阿曲库铵0．1 mg∕kg；PCV2组维持七氟醚呼气末浓度3．5％～4．0％；PSV 组维持七氟醚呼气末浓度2．5％～3．0％，在置入气腹针前静脉注射琥珀胆碱1．0 mg∕kg；PCV1组和PSV组维持Narcotrend指数值50～60，PCV2组维持 Narcotrend 指数值37～45。分别于麻醉诱导前（基础水平）、气腹开始、气腹5 min、气腹10 min、停止气腹、术毕和拔除气管导管时记录HR和MAP ，记录气管导管拔除时间。结果3组麻醉期间SpO2均为100％，麻醉恢复期SpO2均＞95％。与基础值比较，PCV1组和PCV2组拔除气管导管时 HR 增快，MAP 升高（P＜0．05），PSV 组各时点 HR 和 MAP 差异无统计学意义（P＞0．05）。 PCV1组、PCV2组和PSV组气管导管拔除时间分别为30．3±5．4、18．4±4．3、（4．1±1．2） min；与PCV1组和PCV2组比较，PSV组气管导管拔除时间缩短（ P＜0．05）。结论 PSV用于七氟醚麻醉下婴儿腹腔镜疝修补术时，可保证有效通气，麻醉恢复迅速，且拔除气管导管时无心血管反应。

Objective To evaluate the efficacy of pressure support ventilation （ PSV ） in the infants undergoing laparoscopic hernia repair under sevoflurane anesthesia. Methods Thirty ASA physical statusⅠpediatric children, aged 9 months-1 yr, weighing 8.0-11.5 kg, undergoing elective laparoscopic hernia repair, were randomly assigned into 3 groups （ n=10 each） using a random number table： pressure control ventilation （ PCV） used for muscle relaxants in combination with low-concentration sevoflurane group （ group PCV1 ） , PCV used for high-concentration sevoflurane group （ group PCV2 ） , and PSV used for low-concentration sevoflurane group （ group PSV） . Anesthesia was induced with inhalation of 4%-6%sevoflurane and iv fentanyl 2 μg∕kg and succinylcholine 1.5 mg∕kg. The pediatric children were endotracheally intubated and mechanically ventilated. In PCV1 and PCV2 groups, PCV was used during operation. In group PSV, PCV was used first after intubation, and then PSV was applied after spontaneous breathing recovered. Anesthesia was maintained as follows： in group PCV1 , the end-tidal concentration of sevoflurane was maintained at 2.5% - 3.0%, and cisatracurium besylate 0.1 mg∕kg was injected intermittently as required; in group PCV1 , the end-tidal concentration of sevoflurane was maintained at 3.5%-4.0%; in group PSV, the end-tidal concentration of sevoflurane was maintained at 2.5%-3.0%, and succinylcholine 1.0 mg∕kg was injected intravenously before pneumoperitoneum. Narcotrend index value was maintained at 50-60 in PCV1 and PSV groups, or at 37-45 in PCV2 group. Heart rate （ HR） and mean arterial pressure （MAP） were recorded before induction of anesthesia （baseline）, at the beginning of pneumoperitoneum, at 5 and 10 min of pneumoperitoneum, at the end of pneumoperitoneum, at the end of operation and immediately after extubation. The time interval from the end of surgery to extubation was recorded. Results Pulse oxygen saturation was 100% during anesthesia, and〉95% during recovery from anesthesia in the three groups. Compared with the baseline value, HR was significantly faster, and MAP was increased during extubation in PCV1 and PCV2 groups, and no significant change was found in HR and MAP at each time point in group PSV. The time interval from the end of surgery to extubation was 30.3± 5.4, 18.4±4.3 and （4.1±1.2） min in PCV1, PCV2 and PSV groups, respectively. Compared with PCV1 and PCV2 groups, the time interval from the end of surgery to extubation was significantly shortened in group PSV. Conclusion When PSV is applied in the infants undergoing laparoscopic hernia repair under sevoflurane anesthesia, it can provide adequate ventilation, recovery from anesthesia is rapid, and no cardiovascular responses occur during extubation.