联合麻醉2185例临床应用效果分析

目的观察联合麻醉的麻醉效果及不良反应。方法 CEGA组：选择T9-10行硬膜外穿刺置管给药,麻醉平面出现后行全麻诱导气管插管全身麻醉。术中硬膜外麻醉给予0.5-0.7%罗哌卡因3-10ml,以瑞芬太尼持续泵入和异氟醚吸入维持。观察麻醉用药量、拔管时间、麻醉恢复期有无恶心、呕吐及躁动;CSEA组：选择L2-3腰硬联合穿刺,腰麻给予0.75%布比卡因1.3-1.6 ml,麻醉平面不够者予以硬膜外麻醉衔接。观察麻醉开始至切皮时间、术后头痛发生情况;CBGA组：小儿肌注氯胺酮5-6 mg/kg入睡后,行臂丛神经阻滞,术中泵注异丙酚镇静。观察氯胺酮使用情况及术毕患儿苏醒时间。所有患者术中常规监测BP、HR、ECG、RR、SPO2、PETCO2。结果 CEGA组生命体征稳定,全麻用药减少,拔管时间缩短,术后苏醒快,并发症少;CSEA组麻醉开始至切皮时间缩短,术后无头痛发生;CBGA组：麻醉效果满意,氯胺酮使用剂量及次数减少,术后患儿苏醒良好。结论联合麻醉效果完善,并发症及不良反应少,是安全、可靠的麻醉方法 。

The clinical application of 2185 cases with combined anesthesia

Objective To investigate the effect of combined anesthesia and side effects.Methods CEGA groups：epidural puncture was finished in T9-10 lines with catheter placement and administration.When narcotic plane appeared,general anesthesia was implemented.0.5-0.7% ropivacaine with the volume of 3 to 10ml,continuing infusion of remifentanil and inhalation of isoflurane were used to finish the operation.We observed the volume of narcotic drugs,the time of extubation,and the incidence of vomit and restlessness.CSEA groups： We finished combined spinal-epidural puncture in L2-3,with 0.75% bupivacaine given 1.3-1.6 ml in spinal anesthesia.Epidural anesthesia was used when narcotic plane was not enough.The time between the start of anesthesia and skin incision and the incidence of postoperative headache were observed.CBGA groups： Children fell asleep with intramuscular injection of ketamine 5 - 6 mg / kg,and the brachial plexus block was adopted.During the operation,we used continuous infusion of propofol for sedation.The use of ketamine in children and the recovery time were observed.All patients were given the conventional monitoring of BP,HR,ECG,RR,SPO_2,PETCO_2.Results CEGA Groups： In all cases,the vital signs were stable,dosage was reduced in the general anesthesia,extubation time was shorten and all patients woke up fast with few complications.CSEA groups： The time between the start of anesthesia and skin incision was shorten and there were none with headache.CBGA groups： Anesthetic effect was satisfactory.The dosage and frequency of ketamine were decreased.Conclusion The combined anesthesia with perfect effect,less complications and side effects is a safe and reliable method of anesthesia.