CAJ | 학술논문

目的评价坐骨神经阻滞对足部矫形手术患儿七氟醚复合麻醉恢复期躁动的影响.方法择期行足部矫形手术患儿60例,性别不限,年龄3～7岁,体重12～20 kg,ASA分级Ⅰ或Ⅱ级.采用随机数字表法,将其分为2组(n=30):对照组(I组)和坐骨神经阻滞组(Ⅱ组).麻醉诱导后置入喉罩,行人工辅助或机械通气.麻醉维持:吸入七氟醚,呼气末浓度0.5％～2.0％,静脉注射芬太尼0.5 ～ 2.0 μg/kg.麻醉诱导后采用神经刺激器辅助定位实施患侧坐骨神经阻滞,给予0.25％布比卡因0.5 ml/kg.记录喉罩拔除时间和苏醒时间,于麻醉恢复期30 min时进行躁动评分,记录躁动发生情况;于麻醉恢复期10、30 min时行改良面部疼痛评分(FPS-R),并记录麻醉恢复期低氧血症和恶心呕吐等不良反应的发生情况.结果与Ⅰ组比较,Ⅱ组术中芬太尼用量和平均呼气末七氟醚浓度降低,喉罩拔除时间和苏醒时间缩短,躁动发生率、FPS-R评分和低氧血症发生率降低(P＜0.05).结论坐骨神经阻滞有助于降低足部矫形手术患儿七氟醚复合麻醉恢复期躁动发生.
목적 평개좌골신경조체대족부교형수술환인칠불미복합마취회복기조동적영향.방법 택기행족부교형수술환인60례,성별불한,년령3～7세,체중12～20 kg,ASA분급Ⅰ혹Ⅱ급.채용수궤수자표법,장기분위2조(n=30):대조조(I조)화좌골신경조체조(Ⅱ조).마취유도후치입후조,행인공보조혹궤계통기.마취유지:흡입칠불미,호기말농도0.5％～2.0％,정맥주사분태니0.5 ～ 2.0 μg/kg.마취유도후채용신경자격기보조정위실시환측좌골신경조체,급여0.25％포비잡인0.5 ml/kg.기록후조발제시간화소성시간,우마취회복기30 min시진행조동평분,기록조동발생정황;우마취회복기10、30 min시행개량면부동통평분(FPS-R),병기록마취회복기저양혈증화악심구토등불량반응적발생정황.결과 여Ⅰ조비교,Ⅱ조술중분태니용량화평균호기말칠불미농도강저,후조발제시간화소성시간축단,조동발생솔、FPS-R평분화저양혈증발생솔강저(P＜0.05).결론 좌골신경조체유조우강저족부교형수술환인칠불미복합마취회복기조동발생.
Objective To evaluate the effects of the sciatic nerve block on emergence agitation following sevoflurane-based anesthesia in pediatric patients undergoing foot orthomorphia.Methods Sixty pediatric patients,aged 3-7 yr,weighing 12-20 kg,of ASA physical status Ⅰ or Ⅱ,scheduled for elective foot orthomorphia,were randomly assigned to one of two groups (n =30 each):control group (group Ⅰ) and sciatic nerve block group (group Ⅱ).After induction of anesthesia,laryngeal mask airway was inserted,and artificial or mechanical ventilation was performed.Anesthesia was maintained with inhalation of sevoflurane (end-tidal concentration 0.5％-2.0％) and iv fentanyl 0.5-2.0 μg/kg.The sciatic nerve block on the affected side was performed under the guidance of a nerve stimulator,and 0.25％ bupivacaine 0.5 ml/kg was injected.Laryngeal mask airway removal time and emergence time were recorded.At 30 min of recovery from anesthesia,agitation was scored and the development of emergence agitation was recorded.Pain was evaluated with Faces Pain Scale-Revised (FPS-R) at 10 and 30 min of recovery from anesthesia.Adverse reactions including hypoxemia and nausea and vomiting were also recorded during recovery from anesthesia.Results Compared with group Ⅰ,the intraoperative consumption of fen tanyl and mean end-tidal concentration of sevoflurane were significantly decreased,laryngeal mask airway removal time and emergence time were shortened,and the incidence of emergence agitation,PPS-P scores and incidence of hypoxemia were decreased in group Ⅱ.Conclusion The sciatic nerve block is helpful in decreasing the development of emergence agitation following sevoflurane-based anesthesia in pediatric patients undergoing foot orthomorphia.