喉罩下吸入七氟醚联合骶管阻滞麻醉在小儿肿瘤介入治疗的应用

目的探讨喉罩下吸入七氟醚联合骶管阻滞在小儿肿瘤介入手术治疗中的麻醉可行性。方法选择1～13岁择期行肿瘤介入手术患儿40例,随机分成S组（七氟醚吸入组）和P组（静脉组）。S组入室后吸入8%七氟醚,意识消失后插入型号合适的喉罩,连接麻醉机,七氟醚浓度调节到1MAC维持,经骶裂孔注入1%利多卡因溶液（0.8ml/kg,最多25ml）。P组入室后静脉注入丙泊酚2mg/kg,氯胺酮2mg/kg,入睡后再以丙泊酚4mg/（kg.h）,氯胺酮2mg/（kg.h）泵注维持至手术结束。麻醉过程中观察各组患儿诱导前（TO）、麻醉诱导完成时（T1）、手术开始即时（T2）、手术结束时（T3）时的HR、SpO2、MAP变化;记录术中体动及窒息、呛咳发生率,术后恶心呕吐发生率及手术时间术毕苏醒时间。结果 P组T1时刻SpO2显著降低（P〈0.01）;T2时刻HR、MAP显著升高（P〈0.01）。S组术中体动、呛咳发生率显著低于P组（P〈0.05）,术毕苏醒时间显著短于P组（P〈0.01）。结论喉罩下吸入七氟醚联合骶管阻滞麻醉在小儿肿瘤介入治疗中是安全有效可行的。

Sevoflurane by laryngeal mask airway combined with sacral block anesthesia in pediatric tumor interventional therapy

Objective To discuss the feasibility of sevoflurane by laryngeal mask airway combined with sacral block anesthesia in pediatric tumor interventional therapy.Methods To select 40 pediatric patients who were one year old to thirteen years old and then randomly divide into two groups： Sevoflurane （S group） and Vein （P group）. Patients in group P inhaled 8% sevoflurane into lung untill lost consciousness. They were inserted appropriate laryngeal mask airway, maintained unconsciousness with 1MAC sevoflurane.The last,they received sacral block anesthesia with 1% lidocaine solution （1ml/kg, up to25ml）. Patients in group P losted consciousness by intravenous injection of propofol 2mg/kg and ketamine 2mg/kg, pumping maintained unconsciousness until the end of surgery with propofol 4mg/（kg·h）, ketamine 2mg/（kg·h）.Items observed the change of HR、SpO2、MAP among before anaesthesia （T0）, anesthesia induction finished timings （T1）, surgery began timings （T2）, surgery achieved timings （T3）; written the unexpected movements、suffocation 、 cough and vomiting during surgeries ,the lasting time and the recovery time of operation.Results SpO2 in group Swas lower at T1 while HR、MAP was higher at T2 in group P（P0.01）.The rate of unexpected movement、cough in group S was lower than that in group P（P0.05）,the recovery time was shorter than in group P（P0.01）.Conclusion Sevoflurane by undergoing laryngeal mask airway combined with sacral block anesthesia is a safe and effective technique in pediatric tumor interventional therapy.