异丙酚靶控输注联合气管表面麻醉在婴幼儿气管支气管异物取出术中的应用.DOCVIP

临床医学论文-异丙酚靶控输注联合气管表面麻醉在婴幼儿气管支气管异物取出术中的应用 【摘要】? 目的:探讨异丙酚靶控输注联合咽喉、气管内表面麻醉应用于小儿气管支气管异物取出术的疗效，并与氯胺酮复合γ-羟基丁酸钠麻醉效果比较。方法:40例婴幼儿气管、支气管异物患儿，年龄8～36个月，体重7.5～18 kg，随机分为A组和B组。A组为异丙酚效应室靶控输注联合1%丁卡因咽喉、气管表面麻醉，B组为氯胺酮复合γ-羟基丁酸钠麻醉，观察麻醉效果、并发症和苏醒时间。结果:两组患儿均麻醉成功，全部一次顺利插入硬式支气管镜。B组患儿术中最低SpO2低于A组；支气管镜置入后发生较严重屏气、呛咳需处理的病例A组为1例，B组为5例。B组术毕全部病例发生下颌松弛和舌后坠，显著多于A组（1例）（P0.01）。术毕发生喉鸣、托下颌仍吸气困难B组12例，显著多于A组（0例）。B组患儿术毕在手术室滞留时间、苏醒时间长于A组（P0.01）。结论:异丙酚靶控输注联合气管表面麻醉是一种可控性强、安全、实用的婴幼儿气管支气管异物取出术的麻醉方法。 【关键词】? 异丙酚 药物释放系统 表面麻醉 婴幼儿 气管 异物 ??? Abstract:? Objective:To investigate the effect of propofol target controlled infusion(TCI) com-bined throat and trachea topical anaesthesia for the removal of tracheobronchial foreign body in children and compare it to ketamine combined sodium γ-hydroxybutrate anaesthesia. Methods: Forty patients, aged 8～36 months, weighted 7.5～18 kg and scheduled to be undergone removal of tracheobronchial foreign body were randomly enrolled into two groups: group A and group B. Propofol TCI combined throat and trachea topical anaesthesia with 1% decicaine was used in group A. Ketamine combined sodium γ-hydroxybutrate anaesthesia was applied in group B. Effect of anaesthesia, complication and palinesthesia time were observed. Results: Anaesthesia was successful and rigid bronchoscope was inserted smoothly at one time in all patients. The minimum SpO2 in group B was lower than that in group A（P0.01）; The severe breathholding and bucking after inserting bronchoscope were 1 case in group A and 5 in group B. Occurrence of mandibular relax and glossocoma was observed in all patients in group B, while it was only 1 in group A. It was significantly more in group B than that in group A（P0.01）. Laryngeal stridor and dyspnea in inspiration when holding mandibular were observed in 12 patients in group B and none occurred in group A. It was notablely more in group B than that in group A（P0.01）. Comparing with group A. stayed time after surgery in operating room and palinesthesia time were significantly long