小儿腹腔镜疝内环扎术麻醉管理.docVIP

小儿腹腔镜疝内环扎术麻醉管理 　 作者：秦学斌，赵振海，蒋奕红，林高翔 【摘要】 目的 探讨小儿腹腔镜疝内环扎术的麻醉管理。方法 60例行腹腔镜疝内环扎术患儿，随机分为全麻插管组(Ａ组30例)和非插管组(Ｂ组30例)，观察气腹效果、手术时间、呼吸，连续监测HR、SBP、DBP、SaO2，分时段抽动脉血行血气分析。结果 Ａ组、Ｂ组气腹效果优良率分别为100%和80%；两组患者手术时间（min）Ａ组短于Ｂ组(Plt;0.05)；两组患者呼吸比较，B组出现5例窒息，Ａ组无；两组间血气分析，Ｂ组气腹10min，PaCO2、PaO2均明显高于麻醉前(Plt;0.05)，A组气腹10ｍin，PaO2明显高于Ｂ组，组间比较差异有显著性(P＜0.05)。结论 插管和未插管静脉复合麻醉用于小儿腹腔镜疝内环扎术是可行的。但未插管静脉复合麻醉适用于手术时间短的腹腔镜手术，在手术时间＞1ｈ的手术，以气管插管控制呼吸为宜。 【关键词】 小儿；腹腔镜术；腹股沟疝；麻醉 【Abstract】 Objective To study anesthesia management of laparoscopic circumferential internal ring wiring for pediatric indirect inguinal hernia.Methods 60 patients with laparoscopic circumferential internal ring wiring for pediatric indirect inguinal hernia were randomly divided into intravenous anesthesia with endotracheal intubation(A group， 30 cases ) and exemption of endotracheal intubation(B group， 30 cases ). Effects of intraperitoneal air ， operative time， HR， SBP， DBP， SaO2 were recorded continuously， blood gases analysis was performed at planned period. Results The fair ratio of intraperitoneal air of A and B groups were 100% and 80%， A group was shorter than B group in operative time(Plt;0.05)， B group have five asphyxia and A group have not. To compare with B group blood gases analysis， PaCO2， PaO2 were more increased than pre-anesthesia(Plt;0.05) in group B intraperitoneal air 10 minutes， A group was more increased than B group intraperitoneal air 10 minutes. There were different remarkably between group A and B.Conclusion Endotracheal intubation and exemption of endotracheal intubation intravenous anesthesia were suit of laparoscopic circumferential internal ring wiring for pediatric indirect inguinal hernia. But exemption of endotracheal intubation intravenous anesthesia was suit of short operation， control ventilation through endotracheal intubation was better than exemption of endotracheal intubation if the operation was above 1 hour. 【Key words】 pediatric；laparoscopic；inguinal hernia；anesthesia 小儿腹腔镜手术具有时间短、创伤小、恢复快等优点，临