CAJ | 학술논문

目的：比较不同用药方式在腹腔镜小儿疝囊高位结扎术中的麻醉效果。方法240例ASA分级Ⅰ~Ⅱ级拟行腹腔镜疝囊高位结扎术的患儿，随机分为A组（高浓度七氟醚吸入诱导后气管内插管）、B组（高浓度七氟醚吸入诱导，静注0.05 mg/kg的维库溴铵和2μg/kg芬太尼后插管）和C组（高浓度七氟醚吸入诱导，静注0.1 mg/kg的维库溴铵和4μg/kg芬太尼后插管），术中均以2%~3%七氟醚维持，观察气腹开始前5 min (T0)、建立气腹时(T1)、气腹建立后5 min (T2)、术毕放气(T3)、放气后5 min (T4) HR、BP、SpO2、PETCO2、苏醒时间以及术中术后不良反应。结果 A、B、C三组在气腹后HR、BP及PETCO2均有一定程度升高，A组与其他两组比较差异有统计学意义(P<0.05)；B组及C组术中生命体征较A组平稳(P<0.05)；C组苏醒时间较B组及A组显著延长(P<0.05)；A组患儿术中体动反应明显增加且苏醒过程易烦躁(P<0.05）。结论采取气管内插管全身麻醉行腹腔镜下疝囊高位结扎术安全可行，采取B组用药方式可使患儿血流动力学稳定，苏醒时间缩短，围术期并发症减少。
목적：비교불동용약방식재복강경소인산낭고위결찰술중적마취효과。방법240례ASA분급Ⅰ~Ⅱ급의행복강경산낭고위결찰술적환인，수궤분위A조（고농도칠불미흡입유도후기관내삽관）、B조（고농도칠불미흡입유도，정주0.05 mg/kg적유고추안화2μg/kg분태니후삽관）화C조（고농도칠불미흡입유도，정주0.1 mg/kg적유고추안화4μg/kg분태니후삽관），술중균이2%~3%칠불미유지，관찰기복개시전5 min (T0)、건립기복시(T1)、기복건립후5 min (T2)、술필방기(T3)、방기후5 min (T4) HR、BP、SpO2、PETCO2、소성시간이급술중술후불량반응。결과 A、B、C삼조재기복후HR、BP급PETCO2균유일정정도승고，A조여기타량조비교차이유통계학의의(P<0.05)；B조급C조술중생명체정교A조평은(P<0.05)；C조소성시간교B조급A조현저연장(P<0.05)；A조환인술중체동반응명현증가차소성과정역번조(P<0.05）。결론채취기관내삽관전신마취행복강경하산낭고위결찰술안전가행，채취B조용약방식가사환인혈류동역학은정，소성시간축단，위술기병발증감소。
Objective To compare the efficacy of anesthesia among the anesthetic result of different medica-tions for laparoscopic hernial operation in children. Methods Two hundred fourty cases with ASAⅠ~Ⅱ, aged 1 to 2 years old were scheduled for laparoscopic hernial operation. The children were randomly divided into three groups, all re-ceiving endotracheal intubation then maintained with 2%~3%sevoflurane. Group A induced by 5%sevoflurane (80 cases), group B induced by 5%sevoflurane, 0.05 mg/kg vecuronium and 2 μg/kg fentanyl (80 cases), group C induced by 5%sevoflurane, 0.1 mg/kg vecuronium and 4 μg/kg fentanyl (80 cases). The HR, BP, SpO2, PETCO2, recovery time and complications were recorded on T0 (5 min before establishing pneumoperitoneum),T1 (establishing pneumoperitone-um), T2 (5 min after establishing pneumoperitoneum), T3 (remoral of pneumoperitoneum), T4 (5 min after remoral of pneumoperitoneum). Results The HR, BP, PETCO2 levels were significantly increased in all groups when establishing pneumoperitoneum,the change in group A is different from other groups (P<0.05). Intra-operative vital signs of group B and group C is more stable than group A (P<0.05). The recovery time of anesthesia was significantly prolonged in the group C than other groups (P<0.05). The group A had significantly higher incidence rate of irritability and limb exer-cises (P<0.05).Conclusions General anesthesia with endotracheal intubation is safe and feasible for laparoscopic hernial operation in children. As compared with other groups, group B had a satisfactory result.It would effectively maintain he-modynamic steady ,minimize recovery time and reduce complications during the perioperative period for patients.