七氟醚麻醉在小儿气道异物取出术中的应用

摘要

[目的]探讨七氟醚麻醉在小儿气道异物取出术中的应用效果.[方法]随机选取患儿34例,男18例,女16例,年龄1～3岁,体重9～15kg,ASAⅠ～Ⅱ级,病程8～48 h,分为七氟醚组(S组)和氯胺酮组(K组),每组17例.S组吸入8%七氟醚诱导,持续吸入4%～6%七氟醚维持;K组静注氯胺酮1～2 mg/kg诱导,麻醉深度不够时单次静脉追加氯胺酮1 mg/kg.监测患入室时、置镜前、置镜后、术中、退镜后、苏醒时各时间点的平均动脉压(MAP)、心率(HR)、脉搏血氧饱和度(SpO2)、呼吸频率(RR)等指标,观察患儿诱导期、维持期、苏醒期不良反应.[结果]K组患儿置镜前、后MAP、HR 、RR较S组高.K组麻醉诱导时间较S组短,但苏醒时间较S组长(P<0.05).两组均未发生呼吸抑制.术中S组有4例呛咳、3例屏气,K组有3例呛咳、5例屏气,苏醒期S组有3例舌后坠、1例喉水肿;K组有5例舌后坠、3例喉水肿、2例恶心呕吐;两组不良反应的发生率差异无统计学意义(P>0.05).[结论]七氟醚麻醉可安全有效的应用于小儿气道异物取出术.%[Objective] To explore the application of sevoflurane anesthesia in infantile air passage foreign body extrac tion. [Methods] Thirty four ASA Ⅰ～Ⅱ children with the age of 1～3 years old, the weight of 9～l5kg and the course of 8～48h were randomly divided into sevoflurane group(group S) and ketamine group(group K) with 17 cases in each. Group S was induced with 8 ％ sevoflurane and maintained with continue inhalation of 4 ％ ～ 6 ％ sevoflurane. Group K was induced with ketamine 1～2mg/kg and additionally injected with intravenous ketamine 1mg/kg for once if the depth of anesthesia was not enough. The mean arterial pressure(MAP), heart rate(HR), SpO2 and respiratory rate(RR) at different time points including entering time, before and after placing endoscope, during operation, after withdrawal of endoscope and when conscious were monitored. The adverse reactions during induction, maintenance and revival were observed. [Results] Before and after placing endoscope, the MAP, HR and RR in group K were higher than those in group S. The induction time was shorter and the conscious time was longer in group K than those in group S( P ＜0.05). No respiratory depression occurred in both groups. During operation, there were 4 cases of bucking and 3 cases of breathholdlng in group S and 3 cases of bucking and 5 cases of breathholding in group K. During revival, there were 3 cases of glossocoma and one case of laryngeal edema in group S and 5 cases of glossocoma, 3 cases of laryngeal edema and 2 cases of nausea and vomiting in group K. There was no significant difference in the incidence of adverse reactions between two groups( P ＞0.05). [Conclusion] Sevoflurane anesthesia can be used in the infantile air passage foreign body extraction safely and effectively.