肺保护性通气配合静吸复合麻醉在小儿电子耳蜗植入术中的应用效果及安全性

 

目的 探讨肺保护性通气配合静吸复合麻醉在小儿电子耳蜗(CI)植入术中的应用效果及安全性。方法 选取2019-10至2021-10解放军总医院第六医学中心收治的接受CI植入术治疗的重度和极重度感音神经性耳聋(SNHL)患儿80例作为研究对象,采用随机数字表法分为对照组和观察组,每组40例。两组均给予静吸复合麻醉,对照组配合常规通气策略,观察组配合肺保护性通气策略。比较两组常规通气策略/肺保护性通气策略前(T₀)和后30 min(T₁)的血流动力学指标变化、治疗前后的应激反应及麻醉苏醒后不良反应。结果 T₀时,两组HR、MAP和SPO₂差异无统计学意义,T₁时,两组HR、MAP和SPO₂均降低,且观察组均低于对照组(P<0.05),治疗后观察组患者MDA(6.21±0.19)μmol/L]水平显著低于对照组(7.63±0.24)μmol/L],SOD(90.77±11.54)U/L]水平显著高于对照组(72.63±8.49)U/L](P<0.05)。观察组麻醉苏醒后不良反应率(7.50%)低于对照组(27.50%)(P<0.05)。结论 肺保护性通气配合静吸复合麻醉可维持小儿CI植入术中的血流动力学稳定,降低患儿应激反应水平,并减少麻醉苏醒后不良反应的发生,安全可靠。

Effect and safety of pulmonary protective ventilation combined with intravenous inhalational anesthesia in children treated with electronic cochlear implantation

Objective To study the effect and safety of pulmonary protective ventilation combined with intravenous inhalational anesthesia in pediatric electronic cochlear (CI) implantation.Methods Eighty children with severe or very severe sensorineural hearing loss (SNHL) who received CI implantation in the Sixth Medical Center of Chinese PLA General Hospital from October 2019 to October 2021 were selected as the research objects, and they were divided into the control group and the observation group by random number table method, with 40 cases in each group. Both groups were given intravenous inhalation combined anesthesia, the control group with conventional ventilation strategy and the observation group with lung protective ventilation strategy. The hemodynamic indexes before (T₀) and 30 min after (T₁) the ventilation strategy and the adverse reactions after anesthesia were compared between the two groups.Results At T₀, there were no significant differences in HR, MAP and SPO₂ between the two groups. At T₁, HR, MAP and SPO₂ in the two groups decreased, and the indexes of the observation group was lower than those of the control group (P<0.05). After treatment, MDA level (6.21±0.19) μmol/L] in the observation group was significantly lower than that in the control group. SOD level (90.77±11.54) U/L] was significantly higher than that of control group (P<0.05). The rate of the adverse reactions in the observation group (7.50%) was lower than that in the control group (27.50%)(P<0.05).Conclusions Pulmonary protective ventilation combined with intravenous inhalation anesthesia is safe and reliable, which can maintain hemodynamic stability during CI implantation in children, reduce patients’ stress response, and reduce the occurrence of adverse reactions after anesthesia recovery.