七氟醚复合骶管阻滞在小儿泌尿结石手术中应用.docVIP

七氟醚复合骶管阻滞在小儿泌尿结石手术中应用 　　摘要：目的讨论七氟醚吸入复合骶管阻滞在小儿中下腹部泌尿系结石手术中的应用。方法选择6月~5岁择期经膀胱镜或输尿管镜下行气压弹道碎石术治疗的患儿100例，随机分成A组（七氟醚吸入复合骶管阻滞组）和B组（气管插管全麻组），A组入室后吸入8%七氟醚，意识消失后连接麻醉机面罩，七氟醚浓度调到2%维持，经骶管裂孔注入1%利多卡因（1ml/kg），B组患儿入室后在咪唑安定，芬太尼和顺阿曲库铵诱导下行气管插管，术中2%七氟醚维持，按需给予芬太尼和顺阿曲库铵。麻醉过程中观察患儿诱导前（t0），麻醉诱导完成时（t1），手术开始即时（t2），手术结束时（t3）的MAP，HR，SpO2的变化，观察麻醉效果，术毕清醒时间和术后躁动情况。结果两组患儿年龄，体重及手术持续时间比较，差异无统计学意义，与基础值比较，切皮时和术毕时A组麻醉效果与B组相当，差异无统计学意义。但A组清醒时间明显短于B组（P＜0.05)，A组术后发生躁动例数明显少于B组（P＜0.05)。结论七氟醚诱导复合骶管阻滞麻醉效果确切，呼吸管理简便，血流动力学稳定，术后苏醒迅速平稳，几乎毫无精神症状的发生，在中下腹部泌尿手术中的应用安全简便。 　　关键词：七氟醚；骶管阻滞；小儿泌尿结石手术 　　Application of Caudal Block with Sevoflurane Inhalation in Pediatric Urinary Calculi Surgery 　　WANG Yan,LIU Shi-zhong 　　（Department of Anaesthesia,Kashgar No.2 Peoples Hospital,Kashgar 844000,Xinjiang,China） 　　Abstract：ObjectiveTo evaluate the effect of caudal block with sevoflurane inhalation in pediatric urinary calculi in the lower abdominal surgery.MethodsOne hundred children aged 6 months to 5 years old who were scheduled for selective cystoscopy or ureteroscopy pneumatic lithotripsy downstream treatment were randomly divided into Group A(caudal blocksevoflurane inhalation group)and Group B(General anesthesia group).Group A undertook8%sevoflurane inhalation after entering the operating room,linked mask anesthesia machine after loss of consciousness,and sevoflurane concentration was adjusted 2% to maintain,after that,1% lidocaine(1ml/kg)via the sacral hiatus conducted;Group B were anesthetized with midazolam,fentanyl and cis atracurium,after the patients being intubated，anesthesia were maintained with 2% sevoflurane,fentanyl and cis atracurium.The changes of MAP,HR,SpO2 were recorded before induction (t0), after induction (t1),start of operation (t2)and the end of operation (t3).The anesthesia effect,time to consciousness and restlessness at stage of analepsia were also evaluated.ResultsThere was no significance difference between the two groups in terms of age,weight and operating time,nor in terms of anesthesia effects and