儿平稳拔除喉罩时七氟烷的半数有效浓度.DOCVIP

临床医学论文-儿平稳拔除喉罩时七氟烷的半数有效浓度 ????????? 作者：姚玉笙, 陈彦青, 李德龙, 甘秀峰??? 【摘要】? 目的 定量测定50%和95%小儿平稳拔除喉罩时呼气末七氟烷浓度。 方法 25例择期行腹股沟疝修补术患儿,高流量吸入七氟烷和50%氧化亚氮诱导并维持麻醉,不使用肌肉松弛剂及静脉麻醉药物,手术结束后停止吸入氧化亚氮,并维持设定的七氟烷浓度15 min后拔除喉罩。根据Dixon序贯法确定喉罩拔除时的七氟烷浓度,每0.1%七氟烷为1个增减单位。患儿未出现咳嗽、牙关紧闭、体动、屏气及喉痉挛则认为拔除喉罩平稳。 结果 50%及95%小儿平稳拔除喉罩时呼气末七氟烷浓度(即EC50及EC95)分别为1.49%及1.70%(95%的可信区间分别为1.37%~1.59%，1.59%~2.84%)。 结论 3~6岁患儿喉罩满意拔除时呼气末七氟烷EC50和EC95值分别为1.49%和1.70%。 【关键词】? 七氟烷; 麻醉药,吸入; 喉面罩 ??? ABSTRACT:? Objective? To determine the concentrations of sevoflurane where 50%(EC50) and 95%(EC95) of the attempts to remove the laryngeal mask airway(LMA ) would be successful in children.?Methods?Twenty-five nonpremedicated children, aged 3-6 years, ASA physical status I, scheduled for inguinal herniorrhaphy were enrolled in this study.?General anesthesia was induced and maintained with sevoflurane and 50%nitrous oxide in oxygen.?After the surgery, the target concentration was maintained for at least 15 min, and then the LMA was removed.?Each target concentration was predetermined by the Dixons up-and-down method(with 0.1% as a step size) starting at 1.70% concentration of sevoflurane.?A removal accomplished without coughing, teeth clenching, gross purposeful movement, breath holding or laryngospasm, during or within 1 min after removal was considered to be successful.?Results?The concentration of sevoflurane to achieve successful LMA removal in 50% of children was 1.49%(95%CL, 1.37%-1.59%) and in 95% of children was 1.70%(95%CL, 1.59%-2.84%).?Conclusion?The EC50 and EC95 values of sevoflurane for LMA smooth extubation in children aged 3~6 years were 1.49% and 1.70%, respectively. ??? KEY WORDS:? halothane; anesthetics,inhalation; laryngeal masks ??? 喉罩作为一种新型的声门上通气道,近年来广泛应用于麻醉期间的气道管理［1］。临床发现,与麻醉下拔除喉罩相比,小儿清醒拔除喉罩的气道并发症明显增加。而深麻醉拔除喉罩时,过深的麻醉将延长气道保护性反射恢复时间。因此,确定喉罩拔除的时机是十分关键的问题。笔者以呼气末七氟烷浓度作为拔除喉罩时七氟烷麻醉深度指标,定量测定50%和95%小儿平稳拔除喉罩时呼气末七氟烷浓度,为临床实践提供参考。 　　1? 对象与方法 　　1.1? 对象? 　　经过医院伦理委员会批准,监护人签署知情同意书后,共纳入25例择期行单侧腹股沟疝修补术的小儿作为研究对象,男性20例,女性5例,年