经喉罩七氟烷吸入麻醉复合腹股沟区域阻滞在小儿斜疝手术中的应用

The application of the sevoflurane anesthesia via laryngeal mask airway （LMA）composited block in groin ;area in pediatric hernia surgery

目的：观察经喉罩七氟烷吸入麻醉复合腹股沟区域阻滞在小儿腹股沟斜疝手术中的临床效果及其安全性。方法选择择期行腹股沟斜疝疝囊高位结扎术患儿80例，年龄2-6岁，体质量10-25 kg，ASAⅠ-Ⅱ级，按数字表法随机分为两组：喉罩通气下七氟烷复合腹股沟区域阻滞组（S 组）和氯胺酮复合骶管阻滞组（K 组）。S 组采用吸入6％-8％的七氟烷基础麻醉后行静脉诱导：芬太尼2μg／kg，丙泊酚2 mg／kg，待颞下颌关节松弛后置入喉罩，术者消毒铺巾后行腹股沟区域阻滞，术中行机械通气，3％-4％七氟烷吸入维持；K 组采用肌注氯胺酮5 mg／kg 基础麻醉后行改良法骶管阻滞，于切皮前静注氯胺酮1 mg／kg，术中若出现体动、呛咳等反应，追加氯胺酮0．5 mg／kg。分别记录两组切皮前1 min（T0）、切皮后1 min（T1）、切皮后5 min （T2）、术毕（T3）、清醒时（T4）的 MAP、HR；观察术中体动与否、SpO2≤95％及苏醒期躁动的例数，苏醒时间及术后麻醉恢复室停留时间。结果切皮后1 min（T1）、切皮后5 min（T2）、术毕（T3）S 组平均动脉压（MAP）分别为（77．6±6．2）mmHg、（77．8±6．4）mmHg、（76．5±4．7）mmHg，K 组分别为（86．9±8．1）mmHg、（88．1±5.3）mmHg、（86．4±6．5）mmHg，S 组优于 K 组（S 组与 K 组比较，T1、T2、T3时 t 值分别为5．766、7．893、7．806，均 P ＜0．0001）；切皮后1 min（T1）、切皮后5 min（T2）、术毕（T3）S 组心率（HR）分别为（121．3±9．6）次／min、（121．9±8．4）次／min、（120．3±7．8）次／min，K 组分别为（138．6±9．4）次／min、（136．5±7．5）次／min、（128．7±6．9）次／min，S 组优于 K 组（S 组与 K 组比较，T1、T2、T3时 t 值分别为8．144、8．200、5．101，均 P ＜0.0001）。S 组较 K 组患儿术中及恢复期 HR、MAP 更加平稳（均 P ＜0．05）。S 组与 K 组苏醒时间分别为（7．5±3．4）min、（16．7±5．5）min，S 组短于 K 组（S 组与 K 组比较，t 值为8．99，P ＜0．0001）；苏醒时间短（P ＜0．05）、麻醉恢复室停留时间分别为（15．4±4．2）min、（23．7±6．3）min，S 组短于 K 组（S 组与 K 组比较，t 值为6．93，P ＜0．0001）；麻醉恢复室停留时间短（P ＜0．05）；术中体动发生例数 S 组与 K 组分别为3例、15例，K组高于 S 组（χ2＝10．32，P ＜0．001）；SpO2≤95％的发生例数分别为4例、12例，K 组高于 S 组（χ2＝5．00，P ＜0．05）。术中体动及 SpO2≤95％的发生亦少（P ＜0．05）。结论经喉罩七氟烷吸入麻醉复合腹股沟区域阻滞具有诱导快、苏醒快，血流动力学稳定，不良反应较少等优点，可安全应用于小儿麻醉。

Objective To compare the security between the sevoflurane anesthesia via laryngeal mask airway （LMA） composited nerve block in groin area and ketamine anesthesia in the pediatric hemioplasty.Methods 80 children （aged 2 -6,weight 10 -25kg,ASAⅠ -Ⅱ）with high ligation of hernia sac were divided into two groups according to the random number table method：group S -sevoflurane combined with inguinal region block under laryngeal airway ventilation;group K -ketamine combined with caudal block.Group S was inhalated with 6% -8% sevoflurane for foundation anesthesia,and then followed with vein induction：fentanyl 2μg/kg and propofol 2mg/kg.The laryngeal mask was placed when the temporomandibular joint was relaxed.Inguinal region was blocked by the surgeon after disinfect and spread towels.Anesthesia was maintained by 3% to 4% sevoflurane with mechanical ventilation interop-eration.Group K was adopted the intramuscular ketamine （5mg/kg）for basic anesthesia and then used modified sacral canal blocking.Ketamine 1mg/kg was administered before skin incision.Additional ketamine 0.5mg/kg was intravenously injected when it was appeared with body move,choking cough,etc.The values of MAP and HR in the two groups were recorded respectively at the time point of 1min before skin cutting （T0 ）,1min after skin cutting （T1 ）,5min after skin cutting （T2 ）,the end of operation （T3 ）and awaken time （T4 ）.The body movement was observed intraoperation,the number of SpO2≤95% and awaken restlessness,the recovery time and residence time in anesthesia recovery room were recorded.Results The values of MAP in group S at time points of T1 ,T2 ,T3 were （77.6 ±6.2）mmHg,（77.8 ±6.4）mmHg,（76.5 ±4.7）mmHg respectively,and the values of MAP in group K at time points of T1 ,T2 ,T3 were （86.9 ±8.1）mmHg,（88.1 ±5.3）mmHg,（86.4 ±6.5）mmHg respectively.The t values at time points of T1 ,T2 ,T3 were 5.766,7.893,7.806 respectively when the group S compared with group K（P 〈0.0001）,the group S was superior to group K.The values of HR in group S at time points of T1 ,T2 ,T3 were （121.3 ± 9.6）times/min,（121.9 ±8.4）times/min,（120.3 ±7.8）times/min respectively,and the values of HR in group K at time points of T1 ,T2 ,T3 were （138.6 ±9.4）times/min,（136.5 ±7.5）times/min,（128.7 ±6.9）times/min respec-tively.The t values at time points of T1 ,T2 ,T3 were 8.144,8.200,5.101 respectively（P 〈0.0001）,the group S was superior to group K.The MAP and HR were more smoothly in group S than in group K.The recovery time in group S and K was （7.5 ±3.4）min and （16.7 ±5.5）min respectively（t =8.99,P 〈0.0001）,it was shorter in group S than in group K.The residence time in anesthesia recovery room was （15.4 ±4.2）min and （23.7 ±6.3）min respectively （t =6.93,P 〈0.0001）,it was shorter in group S than in group K.Intraoperative body movements was 3 cases and 15 cases respectively in group S and group K（χ2 =10.32,P 〈0.001）;Cases of SpO2 ≤95% was 4 and 12 respec-tively in group S and group K（χ2 =10.32,P 〈0.001）,the occurrence of body movements and SpO2 ≤95% cases was lower in group S than in group K.Conclusion The sevoflurane anesthesia via LMA composited nerve block in groin area has the advantages of faster induction,faster recovery,the hemodynamics was more stable,adverse reactions was fewer and so on,it can be safely used in pediatric anesthesia.