早产儿视网膜病变激光光凝术的麻醉方法及麻醉药物选择

Anesthesia Methods and Anesthetics for Laser Photocoagulation for Retinopathy of Prematurity

早产儿视网膜病变(ROP)是儿童致盲的主要疾病,激光光凝术可有效治疗早期发现的ROP。由于早产儿脑、心、肺、肝、肾等器官往往存在病变,故手术麻醉风险较大。ROP最初均在表面麻醉下行激光光凝术,后复合咪达唑仑、水合氯醛、氯胺酮、吗啡、芬太尼等药物镇静,但均因患儿依从性差、风险高而转为全身麻醉,包括全凭静脉麻醉、全凭吸入麻醉以及静吸复合麻醉,绝大多数都控制气道(气管插管或喉罩)。ROP激光光凝术的麻醉药物以七氟烷应用最多,丙泊酚、瑞芬太尼次之,要求麻醉诱导平稳,麻醉深度易调控,术后患儿苏醒迅速,苏醒后无呼吸抑制。

Retinopathy of prematurity(ROP)is the main cause of blindness in children.Laser photocoagulation is an effective treatment for early detected ROP.Because premature infants often have pathological changes in brain,heart,lung,liver,kidney and other organs,the risk of anesthesia is higher.Surgery is initially performed under surface anesthesia,then followed by sedation with midazolam,chloral hydrate,ketamine,morphine,fentanyl and other drugs latter.However,all these methods eventually are transferred to general anesthesia due to poor compliance of children and high risk.General anesthesia mainly includes total intravenous anesthesia,total inhalation anesthesia and intravenous and inhaled combined anesthesia,most of which have controlled airway(tracheal intubation or laryngeal mask).Sevoflurane is the most widely used anesthetic drug in ROP laser photocoagulation,followed by propofol and remifentanil.It requires stable induction of anesthesia,easy control of the depth of anesthesia,rapid postoperative recovery and no respiratory depression after recovery.