七氟醚复合不同浓度氧化亚氮行幼儿气管插管的临床观察

Effects of sevoflurane with different concentrations of Nitrous Oxide on children's general anesthesia induction

目的观察七氟醚在复合不同浓度氧化亚氮情况下对幼儿全凭吸入麻醉诱导时气管插管的效果。方法将80例择期拟在全身麻醉下行眼科麦粒肿切除术的患儿随机分为S组、LN组、HN组和OA组各20例,ASA分级I级。S组全凭7%七氟醚吸入麻醉诱导,LN组复合7%七氟醚和50%氧化亚氮吸入麻醉诱导,HN组复合7%七氟醚和66%氧化亚氮吸入麻醉诱导,OA组复合7%七氟醚和50%空气吸入麻醉诱导。观察并记录患儿诱导前(T0)、气管插管即刻(T1)、气管插管后2 min时(T2)的心率(HR)、脉搏血氧饱和度(Sp O2)、平均动脉压(MAP),气管插管时间△T(气管插管时间指从吸入诱导开始到气管插管成功的时间)和呼气末麻醉气体浓度(MAC)值,记录气管插管时间和气管插管时Cooper评分。结果 4组患者在各时点的HR、Sp O2、MAP以及气管插管条件Cooper评分相比较差异无统计学意义(P>0.05)。但在T1时刻LN组与HN组的MAC值[(2.45±0.22)%、(2.61±0.21)%]均高于S组与OA组[(2.09±0.31)%、(2.11±0.42)%],P<0.05;4组患者气管插管时间(△T)相比较,LN组与HN组的△T[(137.85±21.49)s和(113.92±28.73)s]均小于S组与OA组[(187.42±30.51)s和(179.34±32.84)s)],同时LN组与HN组的气管插管时间(△T)相比较,HN组的气管插管时间更短,P<0.05。结论七氟醚复合66%氧化亚氮用于幼儿全凭吸入麻醉诱导,能有效缩短麻醉诱导时间,提供良好的插管条件,且并不导致乏氧。

Objective To observe the effects of sevoflurane with different concentrations of Nitrous Oxide on children＇ s general anesthesia induction. Methods A total of 80 ASA I children undergoing ophthalmic hordeolum surgery under general anesthesia were randomly divided into pure oxygen group （group S ）, low nitrous oxide concentration group （group LN）, high nitrous oxide concentration group （group HN ）, and oxygen air group （group OA ）. The children in group S were induced by 7% sevoflurane with pure oxygen,children in group LN induced by 7% sevoflurane with 50% nitrous oxide and 50% oxygen, children in group HN induced by 7% sevoflurane with 66 nitrous oxide and 34% oxygen,children in group OA induced by 7% sevoflurane with 50% air and 50% oxygen. Mean arterial pressure（ MAP）, heart rate （HR）, pulse oxygen saturation （SpO2 ） and minimal alveolar concentration （MAC） value were recorded at the following time points：right before anesthesia induction （TO）, at the time of endotracheal intubation completion（ T1 ） and 2 minutes after endotracheal intubation （T2）. The time of endotracheal intubation （/k T） and the endotracheal intubation conditions were recorded as well. Results There were no significant difference among the four groups on HR, MAP, SpO2 at different time points or the score of Cooper. The MAC values of group S, group LN, group HN and group OA at T1 were （2.09 ±0. 31 ） %, （2.45±0. 22 ） %, （2.61 ± 0.21 ） % and （2.11± 0.42 ） %. The MAC values of group LN and group HN were higher than those in group S and group OA. AT of each group were （ 187.42 ± 30.51 ） s, （ 137, 85±21,49 ） s, （ 113.92 ±8.73 ） s and （ 179.34 ±32.84 ） s respectively. A T of group LN and group HN were shorter than those in group S and group OA, group HNhadthe shortest AT （all P 〈 0.05 ）. Conclusion Induction by sevoflurane with 66% nitrous oxide and 34% oxygen inhalation can shorten the time requiredfor induction and provide comfortable intubation condition without severe lack of oxygen.