喉上神经阻滞联合右美托咪定在婴儿唇腭裂手术中的应用

The application of anesthesia feasibility of superior laryngeal nerve block compound dexmedetomidine for the cleft lip in pediatric patients

目的探讨喉上神经阻滞联合右美托咪定并保留自主呼吸气管插管用于婴儿唇腭裂手术的实用性和可行性。方法选择本院2010年1月到2015年3月底各项检查结果在唇腭裂修复手术允许的安全范围内,符合纳入条件,美国麻醉医师协会（ASA）Ⅰ~Ⅱ级的患儿97例（男性39例,女性58例）,年龄3个月至1岁;体质量5~12kg;手术时间40~130min,将符合入组标准的患儿随机分成A组和B组,其中A组51例（男性19例,女性32例）采取的麻醉方式为喉上神经阻滞联合右美托咪定并保留自主呼吸气管插管后静吸复合全身麻醉,B组46例（男性20例,女性26例）为联合右美托咪定常规静吸复合全身麻醉。2组患儿根据术前要求禁食,禁饮。手术中实时监测分析记录各时间点情况,分别记录患儿气管插管前（T1）、气管插管后5min（T2）、手术进行10min（T3）、手术进行30min（T4）和术后气管拔管后5min（T5）的平均动脉血压（MAP）、心率（HR）、血氧饱和度（SpO2）、术中肌松药量、麻醉药量、苏醒时间,术后出现并发症及其检查分析不良反应的发生率。结果术中监测心率和血流情况表明A和B组之间差异无统计学意义（P〉0.05）,而肌松药量和麻醉药量A组用药量较低（P〈0.05）,拔管时间与清醒时间A组用时更短（P〈0.05）,A组的术后并发症显著降低（P〈0.01）。A组术后躁动评分比B组低很多,有助于唇腭裂婴儿的术后恢复。结论喉上神经阻滞联合右美托咪定保留自主呼吸气管插管复合全身麻醉安全合理,值得推广,可以有效地应用于婴儿唇腭裂手术麻醉术后并发症更少,可以被更好地应用和推广。

Objective To investigate the anesthesia feasibility of superior laryngeal nerve block （SLNB） compound dexmedetomidine（DEX）for the cleft lip in pediatric patients. Methods Our hospital were identified as the cleft lip and palate operations for the children in the welfare. We will choose the volunteer with the examina- tions results being satisfied 97 cases of children （of 39 cases of men, women accounted for 58 cases） were random- ly assigned to two groups （age 3 months to 1 year old; 5-12 kg weight）. Ninty-seven pediatric patients with ASA I - Ⅱ cleft lip were randomly selected into two groups ： A group for SLNB compound DEX general anesthesia and B group for general anesthesia using muscle relaxant intubation. All the infants were forbidden to eat and drink as the operation routine. In order to decrease the effects of atropine on HR （heart rate）, the infants were treated with the few atropine before the surgery. These two groups of infants by the anesthesia nurse pushed into the op- erating room, MAP （mean artery pressure）, HR and SpO2 were observed. The monitoring indexes changes of in- fants in two groups were investigated and compared at the time of before induction （T1）, induction 5 rain （T2）, induction 10 min （T3）, induction 30 min （T4）, after surgery 5 min （T~） during operation. The time of awareness disappearance, recovery time of spontaneous breathing and the extrication time were recorded. The postoperative respiratory secretions, restlessness, nausea and vomiting were observed. Results There was no significant differ- ent between groups in HR and MAP in the two groups （ P 〉0.05）. The removal , waking times and muscle re- laxant in group A were significant shorter than that of group B （ P 〈0.05）. The postoperative complications in group A was lower than that of group B （ P 〈0. 05）. The symptoms of agitated in A group was few than B group. Conclusion The anesthesia effects of SLNB compound general anesthesia is safe and reasonable and has the value worth of promotion. Compared with general anesthesia, the anesthesia effects of SLNB compound general anesthesia is more stable and complications are less.