插管全麻与臂丛阻滞联合非插管全麻用于小儿拇手指再造手术的对比研究

COMPARISON OF INTRATRACHEAL GENERAL ANESTHESIA WITH BRACHIAL PLEXUS BLOCK COMBINED WITH NON-INTRATRCHEAL GENERAL ANESTHESIA IN CHILD THUMB AND FIMGERS RECONSTRUCTION

目的 :对比研究插管全麻与臂丛阻滞联合非插管全麻 ,对小儿拇手指再造手术的麻醉与管理效果的影响。方法 :2 8例 2～ 6岁择期手术患儿 ,随机分为插管全麻组 (G组 ,n =14 )和臂丛阻滞联合非插管全麻组 (BG组 ,n =14 )。G组麻醉诱导依次静注γ -羟基丁酸钠 30～ 6 0mg/kg ,地西泮 0 .1～ 0 .2mg/kg ,1%利多卡因喷喉后 ,经口腔明视插管 ,用T型管法辅助呼吸 ;BG组用 0 .2 5 %布比卡因 1～ 2mg/kg ,施行腋路臂丛阻滞。两组均用0 .1氯胺酮和 0 .0 0 1%芬太尼静脉维持麻醉 ,术中持续给氧。结果 :全麻静脉用药总量BG组非常显著少于G组 (P <0 .0 1) ,清醒时间BG组显著短于G组 (P <0 .0 5 ) ,血液动力学指标术毕后BG组非常显著高于G组 (P<0 .0 1) ,SPO2 术毕后BG组非常显著高于G组 (P <0 .0 1) ,术中吸痰次数 ,术后恶心、呕吐发生率BG组非常显著少于G组 (P <0 .0 1) ,术毕后及回病房后喉、支气管痉挛发生率G组分别为 4 2 .7%和 2 1.4 % ,BG组为零。结论 :两种方法均适用于小儿拇手指再造手术的麻醉 ,但术中麻醉管理臂丛阻滞联合非气管内插管全麻法优于单用气管内插管全麻法。

Objective:To study and compare the effect and anesthesia management between intratracheal general anesthesia(IGA) and brachial plexus block (BPB) combined with non-intratracheal general anesthesia(NIGA) in child thumb and fingers reconstruction.Method:Twenty-eight cases aged from two to six years old were randomly divided into two groups. The IGA was applied in group A (n=14), sodium hydroxybutyrate 30～60mg/kg and diazepam 0.1～0.2 mg/kg were intravenously injected in turn at anesthesia induction stage, then intratracheal intubation was visibly carried out through the mouth after 1% idocaine was sprayed on the throat and assisted respiration with T tube was applied. The BPB combined with NIGA was applied in group B (n=14), 0.25% bupivacaine 1～2 ml/kg was administered in BPB by axillary way. In both groups, 0.1% Retamine hydrochloride and 0.001% fentanyl citrate were administered by i.v. dripping to maintain anesthesia with continuous inhalation of oxygen.Result: The total dosage of anesthetic by i.v. dripping in group B was remarkably less than that in group A ( P <0.01) , and its elimination time of group B was also remarkably shorter than that of group A. The figures of postoperative hemodynamics of group B was obviously higher than that of group A( P <0.01) The frequency of sputum aspiration during operation and the incidene of postoperation nausea and vomitting in group B were obviously lower than that in group A ( P <0.01) . The incidence of postoperative spasm of the largnx and the brochia in group B was 42.7 and 21.4%respectively, but none ofthe group A happened. Conclusion:Both of the IGA and BPB combined with NIGA can be applied in child thumb and fingers reconstruction, but the anesthesia management of the latter was superior to the former.