骶管阻滞联合静脉麻醉在先天性心脏病介入封堵术中的应用

目的探讨骶管阻滞联合静脉麻醉在先天性心脏病介入封堵术患儿中的安全性和有效性。方法将60例择期进行先天性心脏病封堵手术患儿随机分为骶管阻滞联合静脉麻醉组（A组）和单纯静脉麻醉组（B组）。A组静脉给药后进行骶管阻滞,B组单纯静脉麻醉。分别观察诱导前（T₀）、鞘管置入时（T₁）、动、静脉轨道建立时（T₂）、封堵器安放时（T₃）、术后10min（T₄）患儿心率、平均动脉压和血氧饱和度的变化;记录全麻药氯胺酮和丙泊酚的使用量;记录手术时间、苏醒时间、术后5 h疼痛评分、术中体动例数、术后躁动和恶心呕吐等不良反应的例数。结果 A组手术中血流动力学平稳,B组在T₁、T₂、T₃、T₄时间点患儿心率、平均动脉压较诱导前升高（P<0.05）;A组术中体动例数少于B组（P<0.01）,苏醒时间短于B组（P<0.05）;A组患儿全麻药氯胺酮和丙泊酚的使用量少,术后躁动和恶心呕吐等苏醒期不良反应发生率低（P<0.01）,苏醒质量高,手术后5 h疼痛评分显著低于B组（P<0.01）。结论手术期患儿血液动力学平稳,术中体动少,麻醉效果确切;苏醒时间短,术后躁动和恶心呕吐等苏醒期不良反应少,苏醒质量高;术后镇痛作用时间持久。

Application of caudal block combined with intravenous anesthesia for children of congenital heart disease undergoing blocking intervention surgery

Objective To study the efficacy and safety of caudal block combined with intravenous anesthesia for children of congenital heart disease undergoing blocking intervention surgery. Methods 60 patients were randomly divided into two groups.Caudal block combined with intravenous anesthesia was performed on group A and only intravenous anesthesia was used to group B.Both heart rate,mean blood pressure and pulse oxygen saturation before operation, and scabbard tube placement,arteriovenous rail in the building,deviceimplantation 10 min after operation were recorded.Awaking time,postoperative analgesia and postoperative vomiting were also recorded at time points.Results Group A showed hemodynamic stability in perioperative time.But in group B,heart rate and mean blood pressure were significantly higher than those of Group A at time point(P <0.05).Compared with group B,group A showed shorter awaking time(P <0.05),prolonged postoperative analgesia(P <0.01) and few complications.The revival time from anesthesia was shorter in the group A,and they had lower incidence of postoperative vomiting(P <0.01).Conclusion Caudal block combined with intravenous anesthesia is much better than intravenous anesthesia used alone with fewer significant side effects.