小儿腹腔镜手术的麻醉方式选择和术中管理的临床研究

目的:探讨小儿腹腔镜手术麻醉方式和术中麻醉管理。方法:100例行腹腔镜手术患儿,随机分为气管内插管全麻组(1组50例)和未插管静脉复合全麻组(2组50例),连续监测HR、P、BP、SpO2、ECG,PETCO2,麻醉前、气腹后10 min、术后10 min抽血行血气分析,观察CO2气腹效果、手术时间、呼吸情况。结果:1组、2组气腹效果优良率分别为100%和80%;两组患者手术时间(min)1组<2组(P<0.05.);两组患者呼吸监护比较:2组出现5例窒息,4例喉痉挛,l组术中平稳;血气分析:2组气腹10 min,PaCO2、PaO2均明显高于麻醉前(P<0.05),1组气腹10 min,PaCO2低于2组,PaO2明显高于2组,两组比较差异有显著性(P<0.05)。结论:气管内插管全麻比静脉复合全麻用于小儿腹腔镜手术安全、可靠,应为首选。

Clinical Study on Management of Anesthesia For Pediatric Laparoscopic Surgery

Objective:To investigate the methods and management of anesthesia for padiatric laparoscopic surgery.Methods:Based on methods of anesthesia,100 children undergoing laparoscopic surgeries were randomly divided into group 1 with intratracheal intubation(n=50),and group 2 with intravenous combined anesthesia(n=50).The levels of HR,P,BP,SpO2,ECG and PETCO2 were continuously monitored,blood gas analysis were performed before anesthesia,10 mins after pneumoperitoneum or after operation,and the effect of pneumoperitoneum by CO2,duration of surgery and condition of respiration were observed.Results:The rate of fine effect in pneumoperitoneum in group 1 and group 2 was respectively 100%and 80%.The duration of surgery in group 1 was shorter than that in group 2(P<0.05).The monitoring of respiration showed 5 cases of asphyxia,4 laryngospasm in group 2,which were steady in group 1.Blood gas analysis showed the levels of PaCO2 and PaO2 at 10 mins after pneumoperitoneum were higher than that before anesthesia in group 2 (P<0.05).In groupl,the level of PaCO2 was lower and that of PaO2 was higher at 10 mins after pneumoperitoneum than that in group 2,the differences was significant(P<0.05).Conclusion:The technique of intratracheal intuition during general anesthesia is safe,feasible.it should be the first choice for pediatric laparoscopic surgery.