不同麻醉方法取出小儿气管内异物的效果比较

Comparison of effect of different anesthesia on removal of foreign bodies

目的 比较不同麻醉方法对小儿气管内取出异物的临床效果.方法 选择2012年1月～2014年1月收治的80例小儿气管或支气管异物的患儿,按简单数字表法均分为A、B两组各40例,均常规肌肉注射氯胺酮6mg/kg,A组患儿再给予0.1mg/kg咪唑安定,缓慢推注4mg/kg异丙酚,5min后将气管镜置入其内;B组患儿给药方法同A组,在置入气管镜前实施环甲膜穿刺注入2％的利多卡因2ml.分别在进入手术室时（T0）、放镜前（T1）、置入气管镜时（T2）、退出气管镜时（T3）和清醒时（T4）5个时间点记录患者的心电图（ECG）心率（HR）、呼吸（P）、氧饱和度（SpO2）、血压（BP）和氯胺酮总用量等;比较两组患者的手术时间、清醒时间、总用药量、屏气次数、最低SpO2值以及每个时间点的呼吸、血压及心率变化.结果 B组患儿手术时间、清醒时间均比A组短,组间差异有统计学意义（均P＜0.01）;B组患儿屏气次数比A组少,差异有统计学意义（P＜0.05）;A组患儿最低SpO2比B组高,差异有统计学意义（P＜0.01）;B组患儿应用氯胺酮总量明显比A组少,差异有统计学意义（P＜0.01）.置入气管镜到退出（T2、T3）时,B组MPA、HR与麻醉用药前后（T0、T1）比较未见明显差异（均P＞0.05）;A组患儿MPA、HR与麻醉诱导前后比较,差异有统计学意义（均P＜0.05）;两组患儿间的MPA、HR比较,差异有统计学意义（均P＜0.05）.结论 异丙酚静脉麻醉加上环甲膜穿刺气管内局麻能够稳定术中呼吸循环,完善麻醉,缩短苏醒时间,是较为安全有效的麻醉方法.

Objective To study the effect of the different methods of anesthesia on removal of foreign bodies. Methods 80 children with tracheal or bronchial foreign bodies were divided into two groups. All patients were routinely intramuscular injection of ketamine 6mg/kg. 40 cases of group A received 0. lmg/kg of midazolam, propofol was injected slowly after 5min 4mg/kg, the bronchoscope into its internal. 40 cases in group B were treated with group 1 methods and the implementation of cricothyroid membrane puncture in the tracheal mirror before the injection of 2ml 2 % eoncentration of lidocaine. The heart rate during anesthesia （HR）, oxygen saturation （SpO2）, electrocardiogram （ECG）, blood pressure （BP） and breathing were observed. Results The operation time and awake time of group B were shorter than that of group A （P〈0.01）, The breath hold times of group B was less than that of group A （P〈0.05）. SpO2 of group B was higher than that of group A （P〈0. 01）. The amount of ketamine of group B was less than that of group A （P〈0. 01）. MPA and HR before and after inducing were different （P〈0.05）. MPA and HR of the two groups were different （P〈 0. 05）. Conclusion Propofolum intravenous anesthesia and thyrocricocentesis endotracheal anesthesia can stabilize the respiration and circulation, improve anesthesia and shorten awake time, which is a safe and effective anesthesia method.