CAJ | 학술논문

目的比较七氟烷(S)吸入与普鲁泊福(P)联合氯胺酮(K)全凭静脉麻醉用于腹腔镜下小儿腹股沟斜疝手术的麻醉诱导、维持及苏醒特征,为该类手术选择合适的麻醉方式提供依据.方法 ASA分级Ⅰ级、择期行腹腔镜下腹股沟斜疝手术患儿70例.按随机数字表法分为S组与P联合K组(PK组),每组各35例.S组采用吸入S诱导,气管插管后仅吸入S,保持S吸入浓度在1.0～1.5最低肺泡有效浓度(MAC);PK组采用肌肉注射K 6 mg/kg诱导,气管插管后静脉泵注P 80μg/(kg·min)和K 20μg/(kg·min).比较两组患儿麻醉诱导时间、拔除气管导管时间、苏醒时间;麻醉各时间点患儿的心率、平均动脉压(MAP)、脉搏血氧饱和度(SpO_2);苏醒期、术后1～2 d患儿不良反应的发生率.结果 S组患儿麻醉诱导时间、拔除气管导管时间及苏醒时间均短于PK组(P<0.05);S组苏醒期躁动发生率(20.0%,7/35)高于PK组(2.9%,1/35)(P<0.05);术后1d PK组恶心(17.1%,6/35)、呕吐(31.4%,11/35)及睡眠质量差(54.3%,19/35)的发生率高于S组(均为2.9%,1/35)(P<0.05);术后2dPK组睡眠质量差(14.3%,5/35)的发生率仍高于S组(0)(P<0.05).S组及PK组患儿麻醉插管及维持期间循环稳定,S组拔除气管导管时MAP和心率明显升高.结论吸人S或P联合K全凭静脉麻醉用于腹腔镜下小儿腹股沟斜疝手术各有优缺点,仍需从麻醉方式、药物组合等角度筛选出更适合该类手术的麻醉技术.
목적 비교칠불완(S)흡입여보로박복(P)연합록알동(K)전빙정맥마취용우복강경하소인복고구사산수술적마취유도、유지급소성특정,위해류수술선택합괄적마취방식제공의거.방법 ASA분급Ⅰ급、택기행복강경하복고구사산수술환인70례.안수궤수자표법분위S조여P연합K조(PK조),매조각35례.S조채용흡입S유도,기관삽관후부흡입S,보지S흡입농도재1.0～1.5최저폐포유효농도(MAC);PK조채용기육주사K 6 mg/kg유도,기관삽관후정맥빙주P 80μg/(kg·min)화K 20μg/(kg·min).비교량조환인마취유도시간、발제기관도관시간、소성시간;마취각시간점환인적심솔、평균동맥압(MAP)、맥박혈양포화도(SpO_2);소성기、술후1～2 d환인불량반응적발생솔.결과 S조환인마취유도시간、발제기관도관시간급소성시간균단우PK조(P<0.05);S조소성기조동발생솔(20.0%,7/35)고우PK조(2.9%,1/35)(P<0.05);술후1d PK조악심(17.1%,6/35)、구토(31.4%,11/35)급수면질량차(54.3%,19/35)적발생솔고우S조(균위2.9%,1/35)(P<0.05);술후2dPK조수면질량차(14.3%,5/35)적발생솔잉고우S조(0)(P<0.05).S조급PK조환인마취삽관급유지기간순배은정,S조발제기관도관시MAP화심솔명현승고.결론 흡인S혹P연합K전빙정맥마취용우복강경하소인복고구사산수술각유우결점,잉수종마취방식、약물조합등각도사선출경괄합해류수술적마취기술.
Objective To evaluate sevoflurane inhalation and propofol combined with ketamine total venous anesthesia in pediatric laparoscopic surgery of oblique inguinal hernia.Methods Seventy ASA Ⅰ children were randomly divided into two groups,35 children in every group.Children in group S were appliedsevoflurane inhalation[the minimum alveolar concentration(MAC)of sevoflurane was 1.0-1.5],children in group PK were applied ketamine inhalation and total venous anesthesia of propofol[80μg/(kg·min)]with ketamine[20μg/(kg·min)].Compared the time of anesthesia induction,tracheal catheter extubation,anesthesia recovery between the two groups.The mean arterial pressure(MAP),heart rate,pulse oxygen saturation(SpO_2)during anesthesia were compared.During 2 days after operation,the adverse effects such as nausea and vomit,lower grade of sleep quality were also compared.Results Compared with group PK,the time of anesthesia induction,tracheal catheter extubation and anesthesia recovery in group S were shorter (P<0.05),the incidence of emergence agitation in group S was higher(20.0%,7/35 vs 2.9%,1/35)(P<0.05).But nausea(17.1%,6/35),vomit(31.4%,11/35)and lower grade of sleep quality(54.3%,19/35)were higher in group PK than those in groups(all 2.9%,1/35)at 1 day after operation(P<0.05).The incidence of lower grade of sleep quality at2 days after operation in group PK(14.3%,5/35)was higher than that in group S(0)(P<0.05).Cardiovascular effects of children,such as MAP and heart rate during the period of tracheal catheter extubation in group S was higher than that in group PK.Conclusion Sevoflurane inhalation and propofol combined with ketamine total venous anesthesia in pediatric laparoscopic surgery of oblique inguinal hernia still has some disadvantages,the anesthesia technology is selected by anesthesia method and medicine combination.