CAJ | 학술논문

【目的】探讨小儿喉罩麻醉期间采用自主呼吸与容量控制呼吸两种呼吸管理模式对患儿呼吸和循环功能的影响。【方法】收集2013年6月至2014年7月本院收治的小儿外科手术喉罩通气全身麻醉患儿23例，年龄1．3～10岁。丙泊酚静脉复合七氟醚吸入麻醉诱导，全凭七氟醚吸入麻醉维持。喉罩插入后，先保留自主呼吸通气维持15 min ，然后注射小剂量肌松药并转换成容量控制模式。观测并记录患儿基础状态（T0：面罩吸入七氟醚即时）、喉罩插入前（T1）、插入即刻（T2）、自主呼吸10 min（T3）、控制呼吸10 min（T4）、喉罩拔除前（T5）和拔除后（T6）各时间点平均动脉压（MAP）和心率（HR）、自主呼吸频率（RR）、呼末二氧化碳分压（PET CO2）及控制呼吸期间的气道压力。【结果】自主呼吸期间 T3与T2比较，SpO2维持平稳，MAP、HR和PET CO2均明显升高，其差异有显著性（ t ＝6．7、5．8、8．1，均 P ＜0．01）。控制呼吸以后 T4与 T3比较， MAP、HR和PET CO2均明显下降，其差异有显著性（ t ＝6．8、7．1、6．5，均 P ＜0．01）。喉罩拔出前 T5与 T4比较，以手控呼吸过渡，则PET CO2进一步下降（ t＝3．0，P＜0．01）。【结论】小儿喉罩七氟醚麻醉期间，保留自主呼吸存在二氧化碳蓄积的潜在风险，且循环不稳定；容量控制呼吸能够有效改善七氟醚麻醉对小儿呼吸抑制所引起的高碳酸血症，维持循环平稳，安全可靠。
【목적】탐토소인후조마취기간채용자주호흡여용량공제호흡량충호흡관리모식대환인호흡화순배공능적영향。【방법】수집2013년6월지2014년7월본원수치적소인외과수술후조통기전신마취환인23례，년령1．3～10세。병박분정맥복합칠불미흡입마취유도，전빙칠불미흡입마취유지。후조삽입후，선보류자주호흡통기유지15 min ，연후주사소제량기송약병전환성용량공제모식。관측병기록환인기출상태（T0：면조흡입칠불미즉시）、후조삽입전（T1）、삽입즉각（T2）、자주호흡10 min（T3）、공제호흡10 min（T4）、후조발제전（T5）화발제후（T6）각시간점평균동맥압（MAP）화심솔（HR）、자주호흡빈솔（RR）、호말이양화탄분압（PET CO2）급공제호흡기간적기도압력。【결과】자주호흡기간 T3여T2비교，SpO2유지평은，MAP、HR화PET CO2균명현승고，기차이유현저성（ t ＝6．7、5．8、8．1，균 P ＜0．01）。공제호흡이후 T4여 T3비교， MAP、HR화PET CO2균명현하강，기차이유현저성（ t ＝6．8、7．1、6．5，균 P ＜0．01）。후조발출전 T5여 T4비교，이수공호흡과도，칙PET CO2진일보하강（ t＝3．0，P＜0．01）。【결론】소인후조칠불미마취기간，보류자주호흡존재이양화탄축적적잠재풍험，차순배불은정；용량공제호흡능구유효개선칠불미마취대소인호흡억제소인기적고탄산혈증，유지순배평은，안전가고。
[Objective]To explore the effect of respiratory and circulatory function during laryngeal mask airway (LMA) anesthesia using two different kinds of respiratory management in children .[Methods] From June 2013 to July 2014 ,the clinical data were retrospectively analyzed for 23 patients aged 15 month to 10 years undergoing elective operations for laryngeal mask placement .Propofol and fentany were injected intrave‐nously .No neuromuscular blocker was used and spontaneous respiration permitted .After a loss of conscious‐ness ,a LMA was inserted .Anesthesia was maintained with inhalated sevoflurane .Spontaneous respiration was maintained for around 15 min .And volume control ventilation was employed after an intravenous injection of muscle relaxant .Mean arterial pressure (MAP) ,heart rate (HR) ,spontaneous respiration frequency and partial pressure of end‐tidal carbon dioxide were recorded before induction ,before inserting LAM ,at 10 min during spontaneous respiration ,at 10 min during control ventilation ,immediately before removing airway and immediately after removing airway .Airway pressure of control ventilation was recorded .[Results] During spontaneous respiration ,MAP ,HR and partial pressure of end‐tidal carbon dioxide were higher at 10 min than those before inserting LAM .And the differences were statistically significant ( t = 6 .7 ,5 .8 ,8 .1 ,P <0 .001) .During control ventilation ,MAP ,HR and partial pressure of end‐tidal carbon dioxide at 10 min dur‐ing control ventilation were lower than those at 10 min during spontaneous respiration .And the differences were statistically significant ( t=6 .8 ,7 .1 ,6 .5 ,P<0 .001) .Carbon dioxide decreased by hand control venti‐lation before removing LAM .And the differences were statistically significant ( t =3 .0 ,P <0 .001) .[Con‐clusion]During LM A and sevoflurance anesthesia in children ,spontaneous respiration may result in an accu‐mulation of carbon dioxide and unstable hemodynamics .And volume control ventilation can effectively reduce an accumulation of carbon dioxide ,maintain stable hemodynamics and improve safety .