肌松剂在小儿支气管异物取出术麻醉中的应用

目的 通过比较2种麻醉方法在小儿支气管镜检查及异物取出术中的临床效果,探讨肌松剂在小儿支气管镜检查及异物取出术中应用的安全性.方法 选择80例小儿支气管镜检查及异物取出术患儿,按照随机数字表法分为r-羟基丁酸钠-丙泊酚组（A组）40例和咪达唑仑-丙泊酚-芬太尼-维库溴铵组（B组）40例.麻醉诱导：A组,丙泊酚2～3 mg·kg-1,r-羟基丁酸钠80～100 mg·kg-1;B组,咪达唑仑0.1 mg· kg-1,丙泊酚1.5～2.0 mg· kg-1,芬太尼2 μg·kg-1,维库溴铵0.050～0.075 mg· kg-1.下颌松弛后置镜,支气管镜外侧孔接麻醉机螺纹管供氧,A组保留自主呼吸;B组行手控呼吸.2组均在必要时追加丙泊酚维持麻醉,术毕待患儿清醒后回病房.观察2组诱导前、置镜时、退镜后、出手术室前以及术中最高值的HR、MBP,手术时间,苏醒时间（退镜至出手术室的时间）,术中不良事件（HR＞180次·min-1,或者＜70次·min-1,SP02＜80％并持续下降）的发生率和术后并发症（躁动、恶心呕吐、喉水肿、支气管痉挛）的发生率.结果 2组患儿置镜时、退镜后、出手术室前以及术中最高值的HR、MBP B组明显低于A组（均P＜0.05）.B组手术时间及苏醒时间明显较A组短,且术中严重不良事件、术中呛咳、屏气以及术后并发症发生率B组明显低于A组（均P＜0.01）.结论 在小儿支气管镜异物取出术中,1/2～2/3插管剂量的维库溴胺,能较好地抑制患者心血管和气道反应,能保证支气管镜检查及取异物术的顺利进行与麻醉安全.

Application of Muscle Relaxants in Pediatric Patients Undergoing Anesthesia for Foreign Body Removal of Bronchus

Objective To compare the clinical efficacies of two methods of anesthesia and to discuss the safety of muscle relaxants in pediatric patients undergoing bronchoscopy and foreign body removal. Methods Eighty pediatric patients who required bronchoscopy and foreign body removal were randomly divided into two groups, with 40 patients in each group. In group A, anesthesia was induced with propofol 2-3 mg＇kg-1 and r-OH 80-100 mg .kg-1. In group B, anesthesia was induced with midazolam 0.1 mg. kg-1, propofol 1.5-2.0 mg. kg-1, fentanyl 2 p1g, kg-1 and vecuronium 0.050-0.075 mg. kg-1. After jaw relaxation,oxygen supply was performed with anesthesia machine through the threaded tubes and lateral holes.Spontaneous breathing was reserved in group A but manual control breathing was given in group B.If necessary, anesthesia was maintained with additional propofol. Pediatric patients were returned to the ward after wake up. The maximum heart rate （HR）and blood pressure （BP）were measured before anesthesia induction, during placement of the bronchoscope, after withdrawal of the bronchoscope and before leaving the operating room. In addition, operation time, waking time（the time from withdrawal of the bronchoscope to leaving the operating room）,incidence of intraoperative adverse events （heart rate〉180 or 〈70 min-l,SpO2〈80% and kept falling）,and incidence of postoperative complications （restlessness, nausea, vomiting,laryngeal edema and bronchospasm）were recorded in both group. Results Compared with group A,the maximum HR and BP significantly decreased in group B during placement of the bronchoscope, after withdrawal of the bronchoscope andbefore leaving the operating room （P〈0.05）.Compared with group B,operation time,waking time,and incidence of intraoperative adverse events,cough and breathless and postoperative complications significantly increased in group A （all P〈0.01 ）.Conclusion In pediatric patients undergoing bronc- hoscopy and foreign body removal, 1/2 to 2/3 intubation doses of vecuronium can inhibit the cardiovascular and airway reactions and guarantee the successful performance of bronchoscopy and foreign body removal and the safety of anesthesia.