CAJ | 학술논문

目的比较3种麻醉方法在小儿气管异物取出术中的特点.方法采用区段随机法将300例支气管异物患儿随机分为3组(每组100例):A组(氯胺酮+哌替啶+咪达唑仑+右美托咪定组)、B组(氯胺酮+芬太尼+咪达唑仑+顺式阿曲库铵组)、C组(七氟醚+丙泊酚+瑞芬太尼+司可林组).记录置入硬质支气管镜所用时间,询问术者置入支气管镜的难易程度,记录因体动或低氧饱和度而使手术暂停的次数.麻醉过程中严密监测脉搏血氧饱和度(oxygen saturation,SpO2)、心率(heart rate,HR),记录入室(T0)、置镜时(T1)、术毕(T2)、清醒(T3)时的HR、SpO2值,术毕测血气,记录手术时间和苏醒时间.结果 A组患儿T1时HR (106±9)次/min,T2时HR(99±9)次/min,T3时HR(97±10)次/min,苏醒时间(118±10) min,术中有屏气现象,无二氧化碳蓄积现象;与B、C组比较,差异有统计学意义(P＜0.01);B组患儿苏醒时间(58±7) min,比A组时间短,HR较快,术中无屏气现象,有二氧化碳蓄积现象,与A组、C组比较,差异有统计学意义(P＜0.01);C组患儿苏醒时间(21±5) min为3组中最短,HR相对平稳,术中无屏气现象,有二氧化碳蓄积现象,与A组、B组比较,差异有统计学意义(P＜0.01).结论 3种麻醉方法各有特点,应根据患儿的病情及术者的熟练程度选择应用.
목적 비교3충마취방법재소인기관이물취출술중적특점.방법 채용구단수궤법장300례지기관이물환인수궤분위3조(매조100례):A조(록알동+고체정+미체서륜+우미탁미정조)、B조(록알동+분태니+미체서륜+순식아곡고안조)、C조(칠불미+병박분+서분태니+사가림조).기록치입경질지기관경소용시간,순문술자치입지기관경적난역정도,기록인체동혹저양포화도이사수술잠정적차수.마취과정중엄밀감측맥박혈양포화도(oxygen saturation,SpO2)、심솔(heart rate,HR),기록입실(T0)、치경시(T1)、술필(T2)、청성(T3)시적HR、SpO2치,술필측혈기,기록수술시간화소성시간.결과 A조환인T1시HR (106±9)차/min,T2시HR(99±9)차/min,T3시HR(97±10)차/min,소성시간(118±10) min,술중유병기현상,무이양화탄축적현상;여B、C조비교,차이유통계학의의(P＜0.01);B조환인소성시간(58±7) min,비A조시간단,HR교쾌,술중무병기현상,유이양화탄축적현상,여A조、C조비교,차이유통계학의의(P＜0.01);C조환인소성시간(21±5) min위3조중최단,HR상대평은,술중무병기현상,유이양화탄축적현상,여A조、B조비교,차이유통계학의의(P＜0.01).결론 3충마취방법각유특점,응근거환인적병정급술자적숙련정도선택응용.
Objective To compare three general anesthesia methods for retrieve of endobronchial foreign body in children.Methods Three hundred children undergoing endobronchial foreign body retrieve were randomly assigned into three groups:group A (ketamine +pethidine +midazolam +dexmedetomidine),group B (ketamine +fentanyl +midazolam +cis-atracurium),group C (sevoflurane +propofol +remifentanil +succinylcholine).The time required for endobronchoscope insertion,difficulty grade of endobronchoscope placement,and times of the procedure interruption caused by body movement or desaturation were recorded.The artery oxygen saturation (SpO2) and heart rate (HR) were closely monitored during the anesthesia.The HR and SpO2 at entering the OR (T0),endobronchoscope placement (T1),and the end of the procedure (T2),and the time required for consciousness recovery (T3) were observed.The arterial blood-gas analysis was performed at the end of the procedure.The times required for procedure andrecovery were also recorded.Results In group A,HR was (106±9) beats/min,(99±9) beats/min and (97±10) beats/min at observed points of T1,T2 and T3,respectively,time required for recovery was (118±10) min.The breath holding was observed in group A but without carbon dioxide accumulation.In group B,time required for recovery was (58±7) min,Compared to group A and group C,group B had a quicker recovery time and faster HR(P＜0.01).No breath holding was noted in group B but with obvious carbon dioxide accumulation.Group C had the shortest recovery time (21±5) min,a relative stable HR and no breath holding during anesthesia,but with some extent of carbon dioxide accumulation compared to group A and group C (P＜0.01).The rate of hypoxemia was not statistically different among three groups.Conclusions The three general anesthesia methods described above have their advantages and disadvantages.They should be selected based on the physical conditions of the patients and proficiency of the anesthesiologist.