小儿全身麻醉腭裂整复术中机控呼吸与自主呼吸麻醉效果比较

Comparation of the effects of spontaneous breathing and ventilation in children palatorrhaphy during general anesthesia

目的比较保留自主呼吸与机控呼吸在小儿全身麻醉腭裂修复术中的麻醉效果。方法随机选择在行腭裂修复术患儿30例,随机分为两组,每组15例。两组均采用静脉全身麻醉诱导,气管插管后,观察组待自主呼吸恢复后予以保留,对照组组行机控呼吸。两组患儿全程吸入3%七氟醚,并以每次0.5μg/kg的剂量追加芬太尼;观察组自主呼吸频率>30次/min时追加,每次间隔5 min,自主呼吸频率<20次/min时停止;对照组心率大于基础值的30%时追加,直至心率降至正常。记录芬太尼总量、苏醒时间和拔管后有无呼吸抑制。结果与观察组比较,对照组的芬太尼用量增加,苏醒时间延长且拔管后呼吸抑制的发生率高(P<0.05)。结论小儿全身麻醉腭裂修复术中保留自主呼吸并根据呼吸频率调整镇痛药物剂量可减少芬太尼用量,且患者苏醒更快、拔管后呼吸抑制更少。

Objective To compare the effects of spontaneous breathing and ventilation in children palatorrhaphy during generalanesthesia. Methods Thirty patients with ASA I who underment the palatorrhaphies were enrolled and divided into observation group （spontaneous breathing） and control group （ventilation）. Introvenousinduction were performed with both groups and spontaneous breathings were remained in observation group while ventilationswere employed in control group. 3% sevoflurane was inhalated in all patients during operations. A dose of 0. 5 μg/kg fentanyls were added intravenouslyto patients in observation group when their spontaneous breathing rates were more than 30 times/minuntil the rates decreased to 20 times/min with a interval of 5 minutes. Equal doses of fentanyls were added to patientsin control group when their heart rates were more than 30% above the base line until it reduced to the base line. The totaldoses of fentanyls, recovery times and accidents of respiratory depression after extubation were recorded. Results Compared with observationgroup, more fentanyls were injected intravenously, after that recovery times were longer and accidents of respiratorydepression after extuba- tion were higher in patients of control group（ P 〈 0. 05 ）. Conclusion Using the method of adding fentanyl intravenously according to the spontaneous breathing rates in palatorrhaphy, the patients can recover fasterand receive fewer doses of fent- any, meanwhile accidents of respiratory depression after extubation is still cess.