喉罩吸入麻醉在小儿短小手术应用及评价.docVIP

喉罩吸入麻醉在小儿短小手术应用及评价 　　【摘要】目的:探讨喉罩吸入(七氟醚和笑气)麻醉在小儿短小手术麻醉中的使用方法及利弊。方法:选择50例择期手术患儿随机分为两组,即喉罩组(Ⅰ组,25例)和全凭静脉麻醉(Ⅱ组,25例),Ⅰ组患儿吸入七氟醚和笑气(2L/min),每呼吸2～3次手动调节七氟醚蒸发罐浓度增加1%,最大至4%,麻醉至足够深度时,进行静脉输液,然后静脉给予异丙酚2mg#8226;kg-1,芬太尼2ug/kg后,置入喉罩,并连接rager/Fabius型麻醉机,给予手控呼吸,待患儿呼吸恢复后,让其自主呼吸,根据患儿的血压、心率变化及时调节吸入浓度,至手术结束前5～10min控制在1%～2%,直至手术结束时停止。Ⅱ组采用异丙酚(2～8mg#8226;kg-1#8226;h-1)和氯胺酮(1～2mg#8226;kg-1#8226;h-1)持续静脉泵注,2种药物不混合。术中保留自主呼吸,面罩给氧2～3L/min。术毕停止静脉泵注麻醉药。在呼吸道通畅和SpO295%时,患儿苏醒后送返病房,全程密切观察分别记录两组患儿MAP、HR及SpO2,分别于诱导前、切皮、术中和术毕记录上述指标;并记录强刺激引起的肢体活动、SpO20.05),术中及术后map、hr PONV也无显著差异(p0.05),SpO295%。Ⅱ组发生肢体活动9例(36%),SpO295% 7例(28%),明显高于Ⅰ组(P0.05)。结论:喉罩通气装置使用简单、无创伤,喉罩吸入(七氟醚和笑气)较全凭静脉麻醉更安全,对大多数小儿都适用,在小儿短小手术麻醉中的应用值得推广。 　　【关键词】喉罩;吸入麻醉;小儿;全凭麻醉 　　 　　doi:10.3969/j.issn.1006-1959.2010.05.001 文章编号:1006-1959(2010)-05-1025-02 　　Evaluation on applying laryngeal mask airway inhalation in paediatric anaesthetic practice YANG Xing,YANG Tian-de Department of anesthesiology,chong qing three gorges central hospital,wan zhou Chongqing 404000,china 　　【Abstract】Objective:To probe the advantage and the disadvantage between total intravenous anaesthetsia (tiva) and laryngeal mask airway (lma) in pediatric anaesthetic practice during the short term operation.Methods:Fifty children scheduled for elective surgical intervention were randomly divided into ventilated group with lma (n=25) and tiva group (n=25).anesthesia was induced with inspired sevoflurane and nitrous oxide (2L/min) then give fentanyl (2.0 μg/kg),propofol (2.0 mg/kg) and parameter map,hr and spo2 were measured and analyzed statistically before induction of anesthesia,before and after insertion of lma (tt) and after removal of lma (tt).Results:There were no significant differences in map,spo2 and hr between the two groups before the process (p0.05),while in the time after the placement and the removal of lma or tiva,map and hr of lma group were significantly lower than that of tiva group (p0.05).Conclusion:Lma can be widely applied to pediatric anesthesia for its eas