CAJ | 학술논문

目的：通过与氯胺酮基础麻醉比较，评估七氟烷吸入复合应用喉罩在心脏手术患儿麻醉诱导过程中的价值。 　　方法：选取我院2013-08至2014-01择期手术治疗的先天性心脏病患儿40例，无麻醉术前用药，年龄6月~2岁，随机分为七氟烷吸入组（n=20）和氯胺酮肌肉注射组（n=20）。七氟烷吸入组患儿进入手术室后吸入8%七氟烷和100%氧气混合气体，患儿意识消失后插入喉罩，行机械通气，吸入3%~4%七氟烷维持麻醉，然后行颈内静脉置管术。氯胺酮肌肉注射组患儿进入手术室后肌肉注射注氯胺酮（7 mg/kg）+阿托品（0.01 mg/kg），待患儿意识消失后建立外周静脉，经静脉给予咪达唑仑（0.1 mg/kg）、哌库溴铵（0.10 mg/kg）、芬太尼（5μg/kg）后行气管插管、机械通气，辅以0.5%~1%七氟烷维持麻醉，然后行颈内静脉置管术。 　　结果：七氟烷吸入组患儿意识消失时间明显短于氯胺酮肌肉注射组[（48.90±3.93）s vs（577.85±116.41）s， P<0.05]，麻醉开始至完成颈内静脉穿刺时间也明显短于氯胺酮肌肉注射组[（11.15±2.48）min vs（24.15±4.02）min， P<0.05）]。插入喉罩或气管插管后两组在平均动脉压、心率方面差异无统计学意义（P>0.05），且两组在动脉血pH值、动脉血二氧化碳分压、碱剩余、乳酸水平比较差异均无统计学意义（P>0.05）。 　　结论：与氯胺酮肌肉注射基础麻醉比较，七氟烷吸入复合应用喉罩可明显缩短麻醉准备时间，麻醉管理简单平稳，为简单先心性心脏病患儿的心脏手术麻醉准备期提供了更为简单和安全的管理方法，为重症复杂先心性心脏病患儿的心脏手术麻醉准备期提供了重要参考。
목적：통과여록알동기출마취비교，평고칠불완흡입복합응용후조재심장수술환인마취유도과정중적개치。 　　방법：선취아원2013-08지2014-01택기수술치료적선천성심장병환인40례，무마취술전용약，년령6월~2세，수궤분위칠불완흡입조（n=20）화록알동기육주사조（n=20）。칠불완흡입조환인진입수술실후흡입8%칠불완화100%양기혼합기체，환인의식소실후삽입후조，행궤계통기，흡입3%~4%칠불완유지마취，연후행경내정맥치관술。록알동기육주사조환인진입수술실후기육주사주록알동（7 mg/kg）+아탁품（0.01 mg/kg），대환인의식소실후건립외주정맥，경정맥급여미체서륜（0.1 mg/kg）、고고추안（0.10 mg/kg）、분태니（5μg/kg）후행기관삽관、궤계통기，보이0.5%~1%칠불완유지마취，연후행경내정맥치관술。 　　결과：칠불완흡입조환인의식소실시간명현단우록알동기육주사조[（48.90±3.93）s vs（577.85±116.41）s， P<0.05]，마취개시지완성경내정맥천자시간야명현단우록알동기육주사조[（11.15±2.48）min vs（24.15±4.02）min， P<0.05）]。삽입후조혹기관삽관후량조재평균동맥압、심솔방면차이무통계학의의（P>0.05），차량조재동맥혈pH치、동맥혈이양화탄분압、감잉여、유산수평비교차이균무통계학의의（P>0.05）。 　　결론：여록알동기육주사기출마취비교，칠불완흡입복합응용후조가명현축단마취준비시간，마취관리간단평은，위간단선심성심장병환인적심장수술마취준비기제공료경위간단화안전적관리방법，위중증복잡선심성심장병환인적심장수술마취준비기제공료중요삼고。
Objective: Compared with ketamine anesthesia, to investigate sevoflurane inhalation combining laryngeal mask airway for anesthesia induction in pediatric cardiac surgery. Methods:A total of 40 pediatric patients with congenital heart diseases received elective cardiac surgery in our hospital from 2013-08 to 2014-01 were studied. The children were from 6 months to 2 years of age and randomly divided into 2 groups, n=20 in each group. Sevolfurane group, the children inhaled the mixture of 8%sevolfurane and 100%O2, laryngeal mask airway was used upon losing consciousness for mechanical ventilation, the anesthesia was maintained by (3-4)% sevolfurane inhalation to facilitate central venous catheter placement. Ketamine group, the children received intramuscular injection of ketamine (7 mg/kg)+atropine (0.01 mg/kg). The peripheral venous line was established upon losing consciousness, the intravenous midazolam (0.1 mg/kg), pipecuronium (0.10 mg/kg), fentanyl (5 μg/kg) were applied, then tracheal intubation was performed for mechanical ventilation and the anesthesia was maintained by (0.5-1)%sevolfurane to facilitate central venous catheter placement. Results: Sevoflurane group had the shorter time for losing the consciousness than that in Ketamine group (48.90 ± 3.93) s vs (577.85 ± 116.41) s, P<0.05 and the shorter time for ifnishing the central venous catheter placement (11.15 ± 2.48) min vs (24.15 ± 4.02) min, P<0.05. The average blood pressure and heart rate were similar between 2 groups after laryngeal mask or tracheal intubation, P>0.05. The arterial PH value, PaCO2, BE and lactatein were similar between 2 groups, P>0.05. Conclusion: Sevoflurane inhalation combining laryngeal mask airway could shortening anesthesia preparation time with simple management. It provided an important anesthesia option in pediatric cardiac surgery.