CAJ | 학술논문

[目的]探讨小儿泌尿外科阴茎手术面罩下静吸复合全麻合并骶管阻滞的麻醉效果及安全性。[方法]将60例择期行泌尿外科阴茎部位手术的患儿随机分为A组和B组各30例，A组选择传统的静脉复合麻醉联合低位硬膜外麻醉，B组选择面罩下静吸复合麻醉联合骶管阻滞。入麻醉恢复室每10 min进行儿童麻醉后躁动（PAED）评分和婴幼儿麻醉后疼痛评分（CHIPPS），观察两组苏醒期躁动发生率及入手术室时（T1）、切皮时（T2）、切皮后5 min（T3）、切皮后15 min（T4）、术毕时（T5）心率（HR）、收缩压（SBP）、脉搏血氧饱和度（SpO2）、呼吸频率（RR）。并观察阴茎根部手术操作及膀胱造瘘时是否需要辅助全麻镇痛药、两组是否存在恶心呕吐、喉痉挛等麻醉不良事件的发生、及B组需要置入口咽通气道的例数。[结果]B组手术开始后各时点 H R均高于A组，B组术中各时点RR均低于A组。A组有76．6％（23/30）患儿在阴茎根部手术操作时需要辅助全麻镇痛药，两组均无苏醒期躁动病例（PAED评分均小于10分）及术后疼痛病例（CHIPPS评分均小于3分），无恶心呕吐、喉痉挛等不良事件发生。B组有23．3％（7/30）患儿需要置入口咽通气道。[结论]面罩下静吸复合全麻合并骶管阻滞能安全有效地用于小儿泌尿外科阴茎部位手术。
[목적]탐토소인비뇨외과음경수술면조하정흡복합전마합병저관조체적마취효과급안전성。[방법]장60례택기행비뇨외과음경부위수술적환인수궤분위A조화B조각30례，A조선택전통적정맥복합마취연합저위경막외마취，B조선택면조하정흡복합마취연합저관조체。입마취회복실매10 min진행인동마취후조동（PAED）평분화영유인마취후동통평분（CHIPPS），관찰량조소성기조동발생솔급입수술실시（T1）、절피시（T2）、절피후5 min（T3）、절피후15 min（T4）、술필시（T5）심솔（HR）、수축압（SBP）、맥박혈양포화도（SpO2）、호흡빈솔（RR）。병관찰음경근부수술조작급방광조루시시부수요보조전마진통약、량조시부존재악심구토、후경련등마취불량사건적발생、급B조수요치입구인통기도적례수。[결과]B조수술개시후각시점 H R균고우A조，B조술중각시점RR균저우A조。A조유76．6％（23/30）환인재음경근부수술조작시수요보조전마진통약，량조균무소성기조동병례（PAED평분균소우10분）급술후동통병례（CHIPPS평분균소우3분），무악심구토、후경련등불량사건발생。B조유23．3％（7/30）환인수요치입구인통기도。[결론]면조하정흡복합전마합병저관조체능안전유효지용우소인비뇨외과음경부위수술。
[Objective] To explore the efficacy and safety of intravenous inhalation anesthesia under face-mask combined with caudal blockage in pediatric penis surgery .[Methods]Totally 60 pediatric patients sched-uled for urological penis surgery were randomly divided into group A and group B with 30 patients in each group .Group A received traditional intravenous anesthesia combined with lower region epidural blockage , while group B received intravenous inhalation anesthesia under facemask combined with caudal blockage .Pedi-atric anesthesia emergence delirium(PAED) score and children and infants postoperative pain scale(CHIPPS) were performed every 10min after entering recovery room .The incidence of restlessness during the recovery time ,heart rate(HR) ,systolic blood pressure (SBP) ,pulse oxygen saturation (SpO2 ) and respiratory rate (RR) at entering operating room T1 ) ,skin incision(T2 ) ,5min after incision(T3 ) ,15min after incision(T4 ) and after operation(T5 ) in two groups were observed .The demand for adjuvant general anesthetic during the operation of the root of penis or cystostomy ,the incidence of adverse events such as nausea ,vomiting and la-ryngospasm and the number of patients who needed the implantation of oral airway in group B were also ob-served .[Results] HR of group B at each time point after incision was higher than that of group A ,while HR of group B during the operation was lower than that of group A .In group A ,76 .6% (23/30) of patients nee-ded adjuvant anesthetic during the operation of the root of penis .No one of two groups had restlessness(PAED score<10) during the recovery and postoperative pain (CHIPPS score<3) .No adverse event such as nausea , vomiting and laryngospasm occurred .In group B ,23 .3% (7/30) of patients needed the implantation of oral airway .[Conclusion] Intravenous inhalation anesthesia under facemask combined with caudal blockage can be safely and effectively applied in pediatric urologic surgery around penis .