不同用药方式在腹腔镜小儿疝囊高位结扎术中的麻醉效果比较

摘要

目的：比较不同用药方式在腹腔镜小儿疝囊高位结扎术中的麻醉效果。方法240例ASA分级Ⅰ~Ⅱ级拟行腹腔镜疝囊高位结扎术的患儿，随机分为A组（高浓度七氟醚吸入诱导后气管内插管）、B组（高浓度七氟醚吸入诱导，静注0.05 mg/kg的维库溴铵和2µg/kg芬太尼后插管）和C组（高浓度七氟醚吸入诱导，静注0.1 mg/kg的维库溴铵和4µg/kg芬太尼后插管），术中均以2%~3%七氟醚维持，观察气腹开始前5 min (T0)、建立气腹时(T1)、气腹建立后5 min (T2)、术毕放气(T3)、放气后5 min (T4) HR、BP、SpO2、PETCO2、苏醒时间以及术中术后不良反应。结果 A、B、C三组在气腹后HR、BP及PETCO2均有一定程度升高，A组与其他两组比较差异有统计学意义(P<0.05)；B组及C组术中生命体征较A组平稳(P<0.05)；C组苏醒时间较B组及A组显著延长(P<0.05)；A组患儿术中体动反应明显增加且苏醒过程易烦躁(P<0.05）。结论采取气管内插管全身麻醉行腹腔镜下疝囊高位结扎术安全可行，采取B组用药方式可使患儿血流动力学稳定，苏醒时间缩短，围术期并发症减少。%Objective To compare the efficacy of anesthesia among the anesthetic result of different medica-tions for laparoscopic hernial operation in children. Methods Two hundred fourty cases with ASAⅠ~Ⅱ, aged 1 to 2 years old were scheduled for laparoscopic hernial operation. The children were randomly divided into three groups, all re-ceiving endotracheal intubation then maintained with 2%~3%sevoflurane. Group A induced by 5%sevoflurane (80 cases), group B induced by 5%sevoflurane, 0.05 mg/kg vecuronium and 2 µg/kg fentanyl (80 cases), group C induced by 5%sevoflurane, 0.1 mg/kg vecuronium and 4 µg/kg fentanyl (80 cases). The HR, BP, SpO2, PETCO2, recovery time and complications were recorded on T0 (5 min before establishing pneumoperitoneum),T1 (establishing pneumoperitone-um), T2 (5 min after establishing pneumoperitoneum), T3 (remoral of pneumoperitoneum), T4 (5 min after remoral of pneumoperitoneum). Results The HR, BP, PETCO2 levels were significantly increased in all groups when establishing pneumoperitoneum,the change in group A is different from other groups (P<0.05). Intra-operative vital signs of group B and group C is more stable than group A (P<0.05). The recovery time of anesthesia was significantly prolonged in the group C than other groups (P<0.05). The group A had significantly higher incidence rate of irritability and limb exer-cises (P<0.05).Conclusions General anesthesia with endotracheal intubation is safe and feasible for laparoscopic hernial operation in children. As compared with other groups, group B had a satisfactory result.It would effectively maintain he-modynamic steady ,minimize recovery time and reduce complications during the perioperative period for patients.