小儿腹部、下肢手术硬膜外麻醉与静脉麻醉的临床效果比较

Comparison of Clinical Effects between Epidural Anesthesia and Intravenous Anesthesia in Children's Abdominal and Lower Limb Surgery

目的分析并比较小儿腹部、下肢手术硬膜外麻醉与静脉麻醉的临床效果,探讨一种有效的麻醉方法,以确保手术安全。方法选出该院儿外科2019年6月—2020年6月收治的92例腹部、下肢手术患儿,根据不同麻醉方法将其纳入A组与B组各46例,A组应用硬膜外麻醉,B组应用静脉麻醉,对比两组患儿的血流动力学指标(血压、心率、血氧饱和度)、麻醉效果(疼痛反射消失时间、睫毛反射消失时间、睁眼体动时间、术毕至出室时间)、不良反应发生情况(呕吐、反流误吸、支气管痉挛、躁动)。结果A组T1、T2、T3的收缩压高于B组,T2、T3的舒张压高于B组,T2的心率高于B组,差异有统计学意义(P<0.05);A组的疼痛反射消失时间、睫毛反射消失时间、睁眼体动时间与术毕至出室时间(112.65±11.03)s、(60.14±1.54)s、(5.03±0.99)min、(16.98±1.36)min均短于B组(126.93±8.04)s、(66.39±1.63)s、(12.83±1.47)min、(34.06±1.76)min,差异均有统计学意义(t=7.096、18.903、29.850、52.082,P<0.05);A组的不良反应发生率(4.35%)低于B组(17.39%),差异有统计学意义(χ2=4.039,P=0.044)。结论硬膜外麻醉在小儿腹部、下肢手术麻醉中的临床效果优于静脉麻醉,对患儿血流动力学指标的影响较小,且麻醉效果显著,不良反应发生率低。

Objective To analyze and compare the clinical effects of epidural anesthesia and intravenous anesthesia in children's abdominal and lower limb surgery,and to explore an effective anesthesia method to ensure the safety of the operation.Methods A total of 92 children undergoing abdominal and lower extremity surgery were selected from the Department of Pediatric Surgery in the hospital from June 2019 to June 2020.According to different anesthesia methods,they were included in group A and group B,each with 46 cases.Group A was treated with epidural anesthesia.In group B,intravenous anesthesia was applied to compare the hemodynamic indexes(blood pressure,heart rate,oxygen saturation),anesthesia effect(pain reflex disappearance time,eyelash reflex disappearance time,eye-opening body movement time,and completion of the operation time to leave the room),the occurrence of adverse reactions(vomiting,reflux aspiration,bronchospasm,restlessness).Results The systolic blood pressure of T1,T2,T3 of group A was higher than that of group B,the diastolic blood pressure of T2,T3 was higher than that of group B,the heart rate of T2 was higher than that of group B,the difference was statistically significant(P<0.05);the time of pain reflex disappearance,eyelash reflex disappearance,eye opening and body movement and the time from the end of operation to leaving the room in group A were(112.65±11.03)min,(60.14±1.54)s,(5.03±0.99)min,(16.98±1.36)min were shorter than those in group B(126.93±8.04)s,(66.39±1.63)s,(12.83±1.47)min,(34.06±1.76)min,the differences were statistically significant(t=7.096,18.903,29.850,52.082,P<0.05);the incidence of adverse reactions of group A(4.35%)was lower than that of group B(17.39%),and the difference was statistically significant(χ2=4.039,P=0.044).Conclusion Epidural anesthesia is better than intravenous anesthesia in children's abdominal and lower extremity surgical anesthesia.It has less impact on the hemodynamic parameters of children,and the anesthesia effect is significant,and the incidence of adverse reactions is low.