CAJ | 학술논문

目的：比较七氟醚、丙泊酚和氯胺酮麻醉诱导用于小儿支气管镜检异物取出术的效果。方法急诊支气管镜检异物取出术患儿30例，年龄9～58个月，采用随机数字表法将患儿分为三组：七氟醚组（S 组），丙泊酚组（P 组）和氯胺酮组（K 组），每组10例。S 组采用8％七氟醚吸入诱导；P 组采用丙泊酚2.5 mg／kg 缓慢静脉注射诱导；K 组采用氯胺酮5 mg／kg 肌肉注射诱导；三组诱导至意识消失后均以保留自主呼吸为准则，喉镜开口实施利多卡因咽喉部表面麻醉；术中采用靶控输注丙泊酚和瑞芬太尼维持麻醉，面罩吸氧后置入气管镜。记录一次置入气管镜成功率，置入气管镜前后即刻 HR 和 SpO2，置入气管镜时间、气管镜检时间和术后苏醒时间，置入气管镜和术中不良反应发生情况。结果S 组和 P 组成功置入气管镜的时间、术后苏醒时间明显短于 K 组（P＜0.05）；S 组一次置管成功率明显高于 K 组（P＜0.05）。三组患儿不良反应发生率差异无统计学意义。结论与丙泊酚静脉注射和氯胺酮肌肉注射麻醉诱导比较，七氟醚诱导麻醉在婴幼儿气管镜检异物取出术中具有诱导快、苏醒快等优点。
목적：비교칠불미、병박분화록알동마취유도용우소인지기관경검이물취출술적효과。방법급진지기관경검이물취출술환인30례，년령9～58개월，채용수궤수자표법장환인분위삼조：칠불미조（S 조），병박분조（P 조）화록알동조（K 조），매조10례。S 조채용8％칠불미흡입유도；P 조채용병박분2.5 mg／kg 완만정맥주사유도；K 조채용록알동5 mg／kg 기육주사유도；삼조유도지의식소실후균이보류자주호흡위준칙，후경개구실시리다잡인인후부표면마취；술중채용파공수주병박분화서분태니유지마취，면조흡양후치입기관경。기록일차치입기관경성공솔，치입기관경전후즉각 HR 화 SpO2，치입기관경시간、기관경검시간화술후소성시간，치입기관경화술중불량반응발생정황。결과S 조화 P 조성공치입기관경적시간、술후소성시간명현단우 K 조（P＜0.05）；S 조일차치관성공솔명현고우 K 조（P＜0.05）。삼조환인불량반응발생솔차이무통계학의의。결론여병박분정맥주사화록알동기육주사마취유도비교，칠불미유도마취재영유인기관경검이물취출술중구유유도쾌、소성쾌등우점。
Objective Comparing the effect of different anesthetic inductions in pediatric pa-tients undergoing bronchial foreign body removal.Methods Thirty pediatric patients,aged 9-58 months,undergoing emergency bronchial foreign body removal,were randomly into 3 groups (n=10 each):group sevoflurane (group S),group propofol (group P),and group ketamine (group K).Pa-tients in group S were inducted with sevoflurane 8% inhalation,group P with propofol 2.5 mg/kg in-travenous injection,group K with ketamine 5 mg/kg intramuscular injection.Three groups of pa-tients breathed spontaneously during operative period and received topical anesthesia of lidocaine be-fore the placement of rigid bronchoscopy.Combination of intravenous target-controlled infusion of propofol (target plasma concentration of 3-3.5 μg/ml)and remifentanil (target plasma concentration of 2-3 ng/ml)was used for maintenance of anesthesia.The rigid bronchoscopy was inserted after pre-oxygenation for 3 min.Rigid bronchoscopy was performed and the placement time,the first place-ment successfully rate,hypoxemia and side effects as well as postoperative awaking time were recor-ded.Results The first placement successfully rate,group S 90%,group P 70%,group K 40%,with significant difference among three groups (P<0.05).The incidence of side effects were not signifi-cant difference in three groups;In group S and group P,the placement time and the anesthesia awa-king time was significant shorter than that in group K (P<0.05).Conclusion Compared with propo-fol intravenous induction and ketamine intramuscular induction,the high concentration sevoflurane in-duction can provide faster induction,shorter waking time,and reduceside effects in childen undergo-ing bronchial foreign body removal.