CAJ | 학술논문

目的探讨瑞芬太尼、丙泊酚复合罗库溴铵采取高频喷射通气的麻醉用于小儿气管异物取出术的效果及安全性.方法选择一般情况无差异的36例行气管异物取出术的惠儿,年龄在1岁2个月～10岁,随机分为罗库溴铵组(A组)和对照组(B组),每组18例.A组静脉注射丙泊酚、瑞芬太尼和罗库溴铵,消除自主呼吸,插入支气管镜后经侧孔高频喷射通气.B组静脉注射氯胺酮、γ-羟丁酸钠、丙泊酚麻醉,保留自主呼吸,插入支气管镜后经侧孔吸纯氧或必要时高频喷射通气.比较两组患儿的手术时间、苏醒时间；术中术后的心率、动脉血氧饱和度、血压、心电图的变化,记录术中术后发生呛咳、屏气、呼吸暂停.结果 A组术中不良反应及苏醒期并发症发生率较B组明显降低(P＜0.05),手术及苏醒时间较B组明显缩短(P＜0.05).结论在小儿气管异物取出术中,采用丙泊酚瑞芬太尼复合罗库溴铵加用高频喷射通气较传统的保留自主呼吸能更好的维持患儿呼吸循环稳定,缩短手术时间,是一种安全、有效的麻醉方法.
목적 탐토서분태니、병박분복합라고추안채취고빈분사통기적마취용우소인기관이물취출술적효과급안전성.방법 선택일반정황무차이적36례행기관이물취출술적혜인,년령재1세2개월～10세,수궤분위라고추안조(A조)화대조조(B조),매조18례.A조정맥주사병박분、서분태니화라고추안,소제자주호흡,삽입지기관경후경측공고빈분사통기.B조정맥주사록알동、γ-간정산납、병박분마취,보류자주호흡,삽입지기관경후경측공흡순양혹필요시고빈분사통기.비교량조환인적수술시간、소성시간；술중술후적심솔、동맥혈양포화도、혈압、심전도적변화,기록술중술후발생창해、병기、호흡잠정.결과 A조술중불량반응급소성기병발증발생솔교B조명현강저(P＜0.05),수술급소성시간교B조명현축단(P＜0.05).결론 재소인기관이물취출술중,채용병박분서분태니복합라고추안가용고빈분사통기교전통적보류자주호흡능경호적유지환인호흡순배은정,축단수술시간,시일충안전、유효적마취방법.
Objective To investigate the effect and safety of surgery of removing foreign objects in trachea of infants by remifentanil,propofol and recuronium general anesthesia combining with high frequency jet ventilation(HFJV).Methods Thirty-six infant patients underwent removing surgery of foreign objects in trachea were divided into two groups randomly:Group A(propofol,remifentanil and rocuronim) and group B(the control group).Each group in 18 cases.Patients of group A were given intravenous injection of propofol,remifentanil and rocuronim,and eliminated spontaneous breathing.After inserting bronchoscope,high-frequency jet ventilation through the side hole was carried on.Patients of group B were given intravenous injection of ketamine,γ-hydroxybutyrate and propofol to carry on anesthesia and meantime spontaneous breathing was reserved.After inserting bronchoscope,patients absorbed the pure oxygen through the side hole.They were given high-frequency jet ventilation when necessary.During the operation,we continuously monitored electrocardiogram(ECG),heart rate(HR),respiratory (RR) and pulse oxygen saturation(SpO2),and compared various changes of vital sign,the times of patient choking,breath holding,apnea,and bronchospasm,and operation time,recovery time and complications during the recovery period.Results The adverse reaction and complications during the recovery period of group A were significantly lower than those of group B (P ＜ 0.05).Moreover,the surgery and recovery time were significantly shorter than those of group B (P ＜ 0.05).Conclusions During the surgery of removing foreign objects in trachea of infants,the propofol,remifentanil and rocuronim general anesthesia combining with HFJV is superior to the traditional anesthesia keeping spontaneous breathing in maintaining stable respiration and circulation and reducing operation time,it is a safe and effective method of anesthesia.