小儿腹腔镜腹股沟斜疝手术中采用喉罩通气与气管插管麻醉效果观察

目的观察对比在小儿腹腔镜腹股沟斜疝手术中，采用喉罩通气与气管插管的麻醉效果。 方法纳入2019年5月至2020年5月于十堰市妇幼保健院确诊并进行腹腔镜腹股沟疝修补术治疗的患儿100例，按随机数字表法均分为观察组和对照组，每组患儿50例。对照组患儿接受气管插管方式进行麻醉，观察组患儿接受喉罩通气方式进行麻醉。记录所有患儿的基线资料、术中相关指标、血流动力学以及呼吸系统并发症，并进行比较。 结果2组患者临床资料比较，差异无统计学意义（P>0.05）；观察组患儿的麻醉时间、恢复时间、拔管时间[（39.15±6.88）、（4.45±1.85）、（6.15±1.56）min]均短于对照组[（44.95±8.98）、（7.96±1.86）、（13.58±3.28）min]，差异均有统计学意义（P<0.05）；观察组除术前外的各时间点的各项血流动力学指标均明显优于对照组患儿（P<0.05）；观察组患儿的并发症总发生率（10.00%）明显少于对照组（34.00%），差异有统计学意义（P<0.05）。 结论在小儿腹腔镜腹股沟斜疝手术中采用喉罩通气的方式进行麻醉是安全可行的。     

先天性唇、腭裂对患儿呼吸系统顺应性的影响

目的 探讨先天性辰、腭裂对患儿呼吸系统顺应性（ＣＴ）的影响。方法 唇裂或腭裂病儿２４０例（观察组）,非唇腭裂病儿６０例（对照组）均为择期手术患,按年龄段：１～１２月、１～３岁、４～７岁、８～１２岁,各分为５个亚组。全麻诱导气管内插管后,行机械通气,保持ＰＥＴＣＯ２４～４．６ｋＰａ,用Ｄａｔｅｘ Ｕｌｔｉｍａ监测仪测定ＣＴ。结果 与非唇裂同一年龄组ＣＴ值相比,唇裂各年龄组、腭裂１～１２月及１～３岁组     

生长抑素联合空肠营养管在新生儿先天性肠闭锁术后的应用效果观察

目的观察生长抑素联合空肠营养管在新生儿先天性肠闭锁术后的应用效果。方法选择行先天性肠闭锁术新生儿50例,根据不同术后营养治疗方法分为对照组和观察组,每组25例。对照组给予单一生长抑素治疗,观察组给予生长抑素联合空肠营养管治疗,对比两组患儿的手术方式、术后住院时间、体质量变化、不良反应发生情况等。结果两组患者的手术方式比较无明显统计学差异(P0.05);与对照组比较,观察组患者的住院时间明显缩短,3、7、14d的体质量明显增长,差异具有统计学意义(P0.05)。观察组不良反应发生率4.0%(1/25)明显低于对照组32.0%(8/25)(P0.05)。观察组隐血试验转阴时间、血红蛋白下降等情况都显著优于对照组(P0.05)。结论生长抑素联合空肠营养管应用于新生儿先天性肠闭锁术后患儿中,能够改善患儿的营养状态,降低不良反应发生率,具有较高的应用价值。     

复方利多卡因乳膏用于脑动脉瘤夹闭术麻醉预防心血管应激反应研究

目的观察复方利多卡因乳膏用于脑动脉瘤夹闭术全麻插管患者,旨在评价对抑制气管导管刺激引起的心血管应激反应的效果。方法选择40例急、慢诊脑动脉瘤夹闭术患者,ASA为Ⅱ~Ⅳ级,拟施全麻气管插管行动脉瘤夹闭术,并随机分为两组,每组20例。对照组(I组),不使用复方利多卡因乳膏涂抹气管导管,实验组(II组),将复方利多卡因乳膏均匀涂抹气管导管套囊及前端,麻醉诱导后行气管内插管。分别记录患者在麻醉前、插管前、插管时、变动体位、抬头消毒和拔管时平均动脉压(MAP)和心率(HR)。结果插管时与插管前,I组患者明显出现一过性MAP升高和HR增快。而II组插管刺激反应弱于I组。组间与同时刻比较,差异有统计学意义(P0.05)。在变动体位和抬头消毒时与插管前I组仍出现MAP升高和HR增快现象。而II组却无明显变化,组间与同时刻比较,差异有统计学意义(P0.05)。在拔管时与插管前,I组患者明显出现MAP升高和HR增快现象,而II组却弱于I组,组间与同时刻比较,差异有统计学意义(P0.05)。结论将复方利多卡因乳膏均匀涂抹气管导管用于脑动脉瘤夹闭术全麻插管患者,可以有效抑制气管导管刺激引起的心血管应激反应。     

Tracheal sealing characteristics of pediatric cuffed tracheal tubes

BACKGROUND: The aim of the study was to compare sealing characteristics of the new Microcuff pediatric tracheal tube featuring a high volume-low pressure (HVLP) cuff with ultrathin membrane with three conventional pediatric cuffed tracheal tubes. METHODS: After obtaining approval of the local ethical committee, 80 children aged 2-4 years were tracheally intubated with the following tubes (i.d. 4.0 mm) in random order: Microcuff P-HVLP, Mallinckrodt Hi-Contour P, Rüschelit Super Safety Clear, and Sheridan CF. Cuff pressure to prevent air leakage at standardized ventilator setting (PIP 20 cm H2O/PEEP 5 cm H2O/RR 20 min(-1)) was assessed within 5 min after intubation by auscultation of audible sounds at the mouth. Cuff pressures required with each group were compared with Kruskall-Wallis test (P < 0.05). Values are median and range. RESULTS: No significant differences in patient characteristics were found between the four groups. The Microcuff tube required significantly lower sealing pressures [11 cm H2O (6-26)] compared with the other tracheal tube brands [Mallinckrodt: 36 cm H2O (18-48); Rüschelit: 21 cm H2O (8-46); Sheridan: 26 cm H2O (18-60), (P < 0.0001)]. CONCLUSION: This preliminary investigation suggests that the new Microcuff pediatric tracheal tube with ultrathin high volume-low pressure cuff membrane allows effective tracheal sealing at very low cuff pressures. This represents a benefit for children with regard to their lower mucosal perfusion pressures compared with adult patients.     

不同管径胸腔引流管在肺叶切除术后的临床应用比较

目的比较不同管径胸腔引流管在肺叶切除术后的引流效果及对疼痛的影响等。 方法以2012年5月至2014年10月山东省聊城市第二人民医院胸外科90例肺叶切除手术患者为研究对象,于术后安置不同内径的胸部引流管行胸腔闭式引流,比较术后患者带管时间、引流管故障、胸腔积液再穿刺、止痛药物的应用、疼痛评分(NRS)等情况。比较带管时间、NRS评分采用t检验,比较引流管故障、胸腔积液再穿刺、止痛药物应用次数采用χ²检验。 结果粗、细管径组的组间带管时间、引流管故障、胸腔积液再穿刺比较,差异均无统计学意义(P>0.05)。细管径组在术后止痛药物的应用、NRS评分明显低于粗管径组,差异有统计学意义(P<0.05)。 结论细管径引流管因其患者舒适度、依从性好等优点,可在临床上推广使用。     

喉罩全身麻醉复合骶管阻滞在非洲儿童手术中的应用

目的 观察喉罩全身麻醉复合骶管阻滞与单纯气管插管全身麻醉在非洲儿童手术中的应用,为儿童麻醉提供参考. 方法 4～6岁行下腹部及下肢部位择期手术的患儿60例,完全随机分为喉罩全身麻醉复合骶管阻滞麻醉组(A组)和单纯气管插管全身麻醉组(B组),每组30例.观察记录患儿麻醉诱导前(T0)、置入喉罩/气管导管前后(T1、T2)及术毕拔出喉罩/气管导管(T3)时的MAP、HR和Sp02,以及麻醉苏醒时间、术后VAS疼痛评分及副作用情况. 结果 两组患儿MAP、HR和Sp02在To和T1时比较,差异无统计学意义(P＞0.05);A组MAP和HR[(68±10) mmHg(1 mmHg=0.133 kPa)、(108±17)次/min]在T2时明显低于B组[(91±8) mmHg、(139±18)次/min] (P＜0.05);A组MAP和HR[(67±9) mmHg、(121±16)次/min]在T3时也明显低于B组[(85±9) mmHg、(141±17)次/min] (P＜0.05);A组术后VAS评分[(1.5±0.5)分]明显低于B组[(6.5±1.5)分](P＜0.05),A组苏醒时间[(5.8±2.4)min]明显短于B组[(12.2±2.8) min](P＜0.05),A组术后躁动(4例)明显低于B组(17例)(P＜0.05),术后A组啼哭和呛咳的发生率也明显低于B组(P＜0.05). 结论 喉罩全身麻醉复合骶管阻滞麻醉在患儿诱导期和苏醒期有更加平稳的血流动力学,且术后疼痛明显降低、苏醒时间明显缩短、术后副作用发生率明显降低,是非洲儿童下腹部及下肢部位手术的一种较理想的麻醉方法.     

可视喉镜联合管芯和电子软镜引导经鼻气管插管用于口腔科手术患者的效果

目的 评价可视喉镜联合管芯与UE电子软镜引导经鼻气管插管用于口腔科手术患者的效果.方法 选取择期行全麻下经鼻气管插管手术的口腔科患者60例,ASA Ⅰ～Ⅱ级,年龄18～65岁,BMI＜30kg/m2.按随机数字表法分为可视喉镜联合管芯组(K组)和UE电子软镜组(U组),每组30例.记录2组一次置入导管成功率、气管插管时...     

Teaching residents pediatric fiberoptic intubation of the trachea: traditional fiberscope with an eyepiece versus a video-assisted technique using a fiberscope with an integrated camera

BACKGROUND: The authors' hypothesis was that a video-assisted technique should speed resident skill acquisition for flexible fiberoptic oral tracheal intubation (FI) of pediatric patients because the attending anesthesiologist can provide targeted instruction when sharing the view of the airway as the resident attempts intubation. METHODS: Twenty Clinical Anesthesia year 2 residents, novices in pediatric FI, were randomly assigned to either the traditional group (traditional eyepiece FI) or the video group (video-assisted FI). One of two attending anesthesiologists supervised each resident during FI of 15 healthy children, aged 1-6 yr. The time from mask removal to confirmation of endotracheal tube placement by end-tidal carbon dioxide detection was recorded. Intubation attempts were limited to 3 min; up to three attempts were allowed. The primary outcome measure, time to success or failure, was compared between groups. Failure rate and number of attempts were also compared between groups. RESULTS: Three hundred patient intubations were attempted; eight failed. On average, the residents in the video group were faster, were three times more likely to successfully intubate at any given time during an attempt, and required fewer attempts per patient compared to those in the traditional group. CONCLUSIONS: The video system seems to be superior for teaching residents fiberoptic intubation in children.     

平阳霉素治疗小儿口腔颌面部血管瘤及血管畸形的效果分析

目的 探索平阳霉素对小儿口腔颌面部血管瘤及血管畸形的治疗效果。方法 2015年1月至2018年1月,76例口腔颌面部血管瘤及血管畸形患儿根据单盲原则分为对照组(n=38)与治疗组(n=38)。对照组接受地塞米松治疗,治疗组(n=38)接受平阳霉素治疗。对比两组患者的治疗效果和不良反应情况。结果 治疗组有效率显著高于对照组(P<0.05)。治疗组与对照组治疗前瘤体面积差异不显著(P>0.05);治疗后两组患儿瘤体面积均明显减少(P<0.05),且治疗组瘤体面积显著小于对照组(P<0.05)。治疗组不良反应发生率显著低于对照组(P<0.05)。结论 平阳霉素治疗小儿口腔颌面部血管瘤及血管畸形,效果理想,安全性较高,值得临床推广应用。