七氟醚复合丙泊酚在小儿气道异物取出术中的麻醉效果

摘要

目的 观察七氟醚复合丙泊酚在小儿气道异物取出术中的麻醉效果.方法 选择符合美国麻醉学会制定的Ⅰ～Ⅱ级标准、年龄1～4岁、行气管异物取出术小儿 60例,随机数字表法分为七氟醚组和氯胺酮组,每组30例.七氟醚组采用吸入七氟醚诱导麻醉,术中维持药物选用丙泊酚1.5 mg/(kg·h)微泵持续注入,间断吸入七氟醚;氯胺酮组静脉注射咪达唑仑0.1 mg/ks和氯胺酮1.5 mg/kg诱导麻醉,术中麻醉深度不足时分次静脉注射氯胺酮1.5 mg/kg至麻醉满意.记录诱导前(T0)、麻醉诱导后术前1 min(T1)、插入支气管镜时(T2)、拔支气管镜时(T3)、清醒时(T4)血压、心率及血氧饱和度.记录手术时间、苏醒时间和术中医生满意度,观察术中和术后患儿是否有支气管痉挛、呕吐、呼吸道梗阻、舌后坠等并发症.结果 2组患儿T2时收缩压、心率较T0时明显升高.七氟醚组患儿T1时收缩压、心率较T0时明显降低;2组患儿血氧饱和度T1>～T4各时段均较T0时明显升高;七氟醚组患儿苏醒时间显著快于氯胺酮组;七氟醚组患儿医生满意度较氯胺酮组高;术后氯胺酮组患儿舌后坠发生率明显高于七氟醚组,差异有统计学意义(P<0.05).2组患儿T0～T4各时段舒张压、血氧饱和度差异均无统计学意义(P>0.05).结论 七氟醚复合丙泊酚在小儿气道异物取出术中能提供良好的手术条件,术中麻醉平稳,术后患儿苏醒快且苏醒质量较高.%Objective To observe the anesthetic effect of sevoflurane combined with propofol total general anaesthesia in children undergoing tracheal foreign body removal. Methods Sixty patients aged from 1 to 4 years admitted for tracheal foreign body removal were randomly divided into two groups : sevoflurane group (n = 30) and ketamine group (n = 30). In the sevoflurane group, anaesthesia was induced and maintained with inhalation of sevoflurane and propofol [1.5 mg/(kg · h)] was administered continuously for anesthesia maintenance by micro-pump during operation. The ketamine group were pre-medicated with ketamine 6 mg/kg i. m for sedation, then an-aesthesia was induced with midazolam 0.1 mg/kg and ketamine 1.5 mg/kg i. v and was maintained with intravenous bolus of ketamine. Systolic blood pressure(SBP), Diastolic blood pressure(DBP) ,heart rate(HR) and saturation of percutaneous oxygen(SPO2) were monitored in both groups before anaesthesia inducation (T0) , after anaesthesia inducation and before operation (T1), at the time point of bronchial endoscopy(T2) ,endoscope remoral (T3) ,con-sciousness recovery(T4). The operation condition was evaluated by surgeons, and the incidence of bronchial spasm, glossal drop, nausea and vomiting were recorded both during operation and after operation. Results The SBP and HR increased at the time point of bronchial endoscopy in two groups and decreased after anaesthesia inducation in aevoflurane group. The SPO2 increased in two group after anaesthesia inducation. Compared with ketamine group, the time of consciousness recovery was shorter markedly in sevoflurane group. The occurrence of postoperative glossal drop was higher in ketamine group. Conclusion Sevoflurane combined with propofol is safe and effective during general anaesthesia of children undergoing tracheal foreign body removal.