喉罩吸入(七氟醚和笑气)麻醉在小儿短小手术的应用及评价(1)
http://www.100md.com
2010年5月1日
 |
| 第1页 |
参见附件(1469KB，2页)。
【摘要】目的:探讨喉罩吸入(七氟醚和笑气)麻醉在小儿短小手术麻醉中的使用方法及利弊。方法:选择50例择期手术患儿随机分为两组,即喉罩组(Ⅰ组,25例)和全凭静脉麻醉(Ⅱ组,25例),Ⅰ组患儿吸入七氟醚和笑气(2L/min),每呼吸2～3次手动调节七氟醚蒸发罐浓度增加1%,最大至4%,麻醉至足够深度时,进行静脉输液,然后静脉给予异丙酚2mg•kg-1,芬太尼2ug/kg后,置入喉罩,并连接rager/Fabius型麻醉机,给予手控呼吸,待患儿呼吸恢复后,让其自主呼吸,根据患儿的血压、心率变化及时调节吸入浓度,至手术结束前5～10min控制在1%～2%,直至手术结束时停止。Ⅱ组采用异丙酚(2～8mg•kg-1•h-1)和氯胺酮(1～2mg•kg-1•h-1)持续静脉泵注,2种药物不混合。术中保留自主呼吸,面罩给氧2～3L/min。术毕停止静脉泵注麻醉药。在呼吸道通畅和SpO2>95%时,患儿苏醒后送返病房,全程密切观察分别记录两组患儿MAP、HR及SpO2,分别于诱导前、切皮、术中和术毕记录上述指标;并记录强刺激引起的肢体活动、SpO2<95%和PONV发生的例数。结果:两组患儿在麻醉诱导前及lma置入前后的map、hr、spo2值相比较无显著差异(p>0.05),术中及术后map、hr PONV也无显著差异(p>0.05),SpO2<95%Ⅰ组无一例发生肢体活动,SpO2<95% 2例(8%),经调整喉罩位置并辅助呼吸后SpO2>95%。Ⅱ组发生肢体活动9例(36%),SpO2<95% 7例(28%),明显高于Ⅰ组(P<0.05)。结论:喉罩通气装置使用简单、无创伤,喉罩吸入(七氟醚和笑气)较全凭静脉麻醉更安全,对大多数小儿都适用,在小儿短小手术麻醉中的应用值得推广。
【关键词】喉罩;吸入麻醉;小儿;全凭麻醉
doi:10.3969/j.issn.1006-1959.2010.05.001 文章编号:1006-1959(2010)-05-1025-02
Evaluation on applying laryngeal mask airway inhalation in paediatric anaesthetic practice YANG Xing,YANG Tian-de Department of anesthesiology,chong qing three gorges central hospital,wan zhou Chongqing 404000,china
【Abstract】Objective:To probe the advantage and the disadvantage between total intravenous anaesthetsia (tiva) and laryngeal mask airway (lma) in pediatric anaesthetic practice during the short term operation.Methods:Fifty children scheduled for elective surgical intervention were randomly divided into ventilated group with lma (n=25) and tiva group (n=25).anesthesia was induced with inspired sevoflurane and nitrous oxide (2L/min) then give fentanyl (2.0 μg/kg),propofol (2.0 mg/kg) and parameter map,hr and spo2 were measured and analyzed statistically before induction of anesthesia,before and after insertion of lma (tt) and after removal of lma (tt).Results:There were no significant differences in map,spo2 and hr between the two groups before the process (p>0.05),while in the time after the placement and the removal of lma or tiva,map and hr of lma group were significantly lower than that of tiva group (p<0.05).Conclusion:Lma can be widely applied to pediatric anesthesia for its easy operation and non-invasion.
【Key words】Laryngeal mask airway;Inhalation;Pediatrics;Total intravenous anaesthesia
喉罩(laryngeal mask airway,lma)是安置于咽喉腔、用气囊封闭食管和咽喉腔、经咽喉通气的人工气道作为一种通气道控制技术,喉罩技术(LMA)用于短小手术,术中保留自主呼吸的全麻病人能维持呼吸道通畅,且麻醉深度能满足手术要求[1,4],1983年在国外开始应用于临床,在英国很多医院的使用率可达全麻的5o%以上[5] ......
您现在查看是摘要介绍页，详见PDF附件(1469KB，2页)。