先天性肥厚性幽门狭窄手术麻醉管理

目的观察先天性肥厚性幽门狭窄新生儿插管与非插管全身麻醉的有效性及安全性,为临床提供应用理论依据。方法先天性肥厚性幽门狭窄婴儿40例,年龄1～3个月,均分为氯胺酮组（K组）和插管组（E组）,根据术前是否酸碱失衡分为正常者K1、E1组,异常者K2、E2组;监测麻醉诱导（T1）、手术切皮（T2）、出手术室（T1）时的BP、HR、ECG、SpO2、ETCO20观察术中分泌物、术中屏气次数及术后烦躁例数行为学指标;监测麻醉诱导（T1）和出手术室（T3）时的血气。结果四亚组问T1、T2时刻MAP、HR、SpO2、ETCO2无统计学差异,T3时刻K2组较其他三亚组MAP、HR、SpO2均低,而ETC02均高,ECG无异常出现。术中出现呼吸抑制,需要处理者K2组较其他三亚组均高。术后烦躁K2组明显多于其他三个亚组。结论先天性肥厚性幽门狭窄麻醉选择全身麻醉。插管全身麻醉较非插管全身麻醉更安全。非酸碱失衡者,选择插管全身麻醉及非插管全身麻醉均可;但伴随酸碱失衡者。插管全身麻醉更安全。

Anesthesia management of baby congenital hypertrophic pyloric stenosis

Objective To observe the efficacy and and without general anesthesia intubation, provide safety of congenital hypertrophic pyloric stenosis in neonates with theoretical basis for clinical. Methods There were 40 infants with congenital hypertrophic pyloric stenosis. The age was between 1 and 3 months. All the babys were divided into the ke- tamine group （K group） and intubation group （E group）. According to preoperative acid-base imbalance were divided into normal group （K1/E1） and abnormal group （K2/E2）; BP, HR, ECG, SpO2 and ETCO2 were monitored in anesthetic in- duction （T1）, skin incision （T2） and the operating room （T3）; the secreta and breath holding in operation, and dysphoria after operation were observed; the sap in T1 and T3 were monitored. Results No significant statistically differences be- tween the four groups of MAP, HR, SpO2, ETCO2 in T1 and T2. The MAP, HR and SpO2 were lower in K2 group than other groups in T3, but ETCO2 was higher and ECG was regular. It was higher in K2 group than other groups for respi- ratory inhibition appeared in operation and dysphoria after opreation. Conclusion It is safer in general anesthesia intu- bation than without general anesthesia intubation for congenital hypertrophic pyloric stenosis. If acid-base is balance, both methods are applicable. But in acid-base imbalance, general anesthesia is safer.