组合式吸入麻醉诱导装置在急诊儿童肱骨髁上骨折手法复位中的应用及其效果分析

目的:观察组合式吸入麻醉诱导（combined inhalation anesthesia induction，CIAI）装置吸入七氟醚在急诊儿童肱骨髁上骨折手法复位的应用效果。方法:本研究为对照试验。2015年7月至2020年5月于陆军第七十三集团军医院急诊科就诊的需行手法复位的儿童肱骨髁上骨折患儿81例，其中男42...

Effect of application of combined inhalation anesthesia induction device in emergency manual reduction of children with humeral supracondylar fracture

Objective　To observe the effect of sevoflurane inhalation via the combined inhalation anesthesia induction device (CIAI) in emergency manual reduction of humeral supracondylar fracture in children. Methods　This was a control trial. Eighty-one children with humeral supracondylar fracture took manual reduction in Emergency Department, Hospital of 73th Army Group of Land Force from July 2015 to May 2020,including 42 males and 39 females, and they were 2 to 5 (3.24±1.71) years old. The patients were divided into a CIAI Group (42 cases) and a control group (39 cases). Before the manual reduction, the CIAI group were given sevoflurane 2-5 ml/time by the combined inhalation anesthesia induction device, while the control group were given propofol 3-4 mg/kg intravenously. Before (T1) and during (T2) the manual reduction and when the children came to (T3), the heart rates, oxygen saturations (SpO₂), mean arterial pressures (MAP), Ramsay Sedation scores, The Face, Legs, Activity, Cry, Consolability Behavioral Tool (FLACC) scores, frequencies of adding drugs, and incidences of adverse reactions were statistically analyzed. The Shapiro-Wiktest test was used to evaluate the normality of the measurement data. The measurement data of normal distribution were expressed as (x±s), and were compared between the two groups by independent-sample t test. Results　At T1, there were no statistical differences in MAP, HR, and SpO₂ between the two groups (all P>0.05). The MAP, HR, and SpO₂ at T2 and T3 were (69.9±5.1) mmHg (1 mmHg=0.133 kPa) and (69.1±4.1) mmHg, (109.5±8.1) beats/min and (103.9±6.3) beats/min, and (98.9±0.7) mmHg and (98.9±0.8) mmHg in the control group, and were (69.1±5.8) mmHg and (69.5±5.1) mmHg, (93.6±2.9)  beats/min and (95.6±5.6)  beats/min, and (99.3±0.6) mmHg and (99.5±0.5) mmHg in the CIAI group, with lower fluctuations in the CIAI group (all P<0.05). There were no statistical differences in the Ramsay and FLACC scores between the two groups before and after the manual reduction (all P>0.05). The CIAI group fell asleep slower and recovered faster than the control group (38.2±10.3) s vs. (24.2±4.5) s and (5.8±1.9) min vs. (20.1±4.5) min; both P<0.05]. The incidences of restlessness and increased oral secretion and the total incidence of adverse reactions in the CIAI group were lower than those in the control group (all P<0.05). Conclusion　Compared with the traditional intravenous administration of propofol, the inhalation of sevoflurane by the combined inhalation anesthesia induction device in children with humeral supracondylar fracture in the operation room has ideal clinical outcomes. It is more humanized in the application process, with ideal safety, more convenience, high comfort, low cost, and fewer adverse reactions. Therefore, it is suitable for further clinical application and promotion.