舒芬太尼复合氯胺酮在幼儿支气管异物取出术中应用.docVIP

舒芬太尼复合氯胺酮在幼儿支气管异物取出术中应用 　 作者：叶志刚，李长科，范开明,何丽娟,万震威 【摘要】 目的：探讨舒芬太尼复合氯胺酮在幼儿支气管异物取出术中应用的可行性及安全性。方法：42例需行支气管异物取出术的患儿随机分为舒芬太尼(S组与芬太尼(F组，两组均在氯胺酮诱导后行气管内插管控制呼吸，S组静注并持续泵入舒芬太尼，F组分次静注芬太尼，采用纤维支气管镜钳(套取异物。记录两组不同时间点HR、SpO2、平均动脉压(MAP及镜检满意度、自主呼吸恢复时间(Tr、出室时间(To。结果：Tr、To S组明显短于F组(Plt;0.01，镜检满意度优于F组(Plt;0.05；F组HR、MAP插镜后均比插管后提高(Plt;0.05,S组各时间点HR、MAP比无统计学意义。结论：舒芬太尼复合氯胺酮在支气管异物取出术中的应用良好，提高了手术安全性。 【关键词】 舒芬太尼；氯胺酮；支气管镜检 ［Abstract］Objective:To investigate the feasibility and safety of application of sufentanyl combined ketamine in removal foreign bodies from bronchi in children. Methods：Forty_two children undergoing removal of foreign bodies from bronchi were randomly assigned into sufentanil group and fentunyl group. Anesthesia was induced with ketamine, and maintained with sufentanil by continuing intravenous injection in the sufentanil group, with fentunyl by intermittent intravenous injection in the fentunyl group. The bronchfiberscopy forcep was applied to remove foreign bodies. HR、SpO2、MAP between two groups were recorded at different time points. The degree of satisfaction of operation, spontaneously breathing recovery time(Tr, out room time(Towere recorded between two groups. Results： Tr， To in the sufentanil group were lower than those in the fentunyl group(Plt;0.01, and the degree of satisfaction of operation was better(Plt;0.05, HR、MAP after bronchfiberscopy inset were higher than those after tracheal intubation in the fentunyl group(Plt;0.05, but those were no diference at different time points in the sufentanil group. Conclusion： The application of sufentanyl combined ketamine in removal foreign bodies from bronchi in children is feasibe and safe. ［Key Words］sufentanil，ketamine，bronchoscopy examination支气管异物是耳鼻喉科常见急症，也是小儿急性呼吸道梗阻常见原因，手术取出异物面临高难度与高风险，而纤维支气管镜提高了手术成功率。合适的麻醉方式，也可为手术实施的安全和高效创造有利条件。本文旨在探讨不同麻醉药组合对患儿术后复苏的影响。 1 资料与方法 1.1 一般资料 42例患儿中男性27例，女性15例。年龄最小1岁，最大3岁，平均(1.8±0.75岁。体质量最小9.2kg，最大15.5kg，平均(11.2±1.28kg。支气管异物：瓜子、花生米、甘蔗屑、水果肉、笔套螺帽等。异物位于右侧支气管23例，左侧17例，双侧2例。所有患儿术前病情相对平稳，静息状态下吸