静脉留置针持续骶麻复合丙泊酚镇静在婴幼儿脐以下手术中的应用

目的探讨婴幼儿脐以下手术使用骶管持续阻滞并丙泊酚持续镇静的效果及安全性。方法选5个月～3岁、行脐以下手术的婴幼儿40例,随机分两组:持续骶麻复合丙泊酚辅助组(A组,n=20)和氯胺酮丙泊酚复合静脉全麻组(B组,n=20)。在基础麻醉后:A组用静脉留置针行骶管穿刺胶布固定留置,0.8%～1.2%的利多卡因持续阻滞,丙泊酚4～6 mg/(kg.h)静脉辅助镇静;B组用氯胺酮丙泊酚混合液(1∶1)按氯胺酮30～50μg/(kg.min)微泵持续注射。记录并比较两组患儿麻醉诱导前、麻醉诱导后、切皮时、术中、术毕血压(BP)、心率(HR)、呼吸(R)和血氧饱和度(SpO2),苏醒时间及不良反应。结果两组患儿生命基础值间无显著性差异(p>0.05),B组的MBP在诱导至术毕间各时段及HR、R在切皮、术中术毕均有显著性升高(p<0.05),而A组则相对较为平稳;A组的苏醒时间和不良反应明显少于B组(p<0.01)。结论静脉留置针行持续骶麻复合丙泊酚镇静在婴幼儿脐以下手术中效果确切,麻药用量少,苏醒时间短,并发症少,安全可靠,值得推介。

THE APPLICATION OF CONTINUOUS CAUDAL ANESTHESIA BY VENOUS INDWELLING NEEDLE COMBINED WITH PROPOFOL SEDATION IN INFANTS OPERATIONS BELOW THE NAVEL

Objective To study the effects and safety of continuous blockage by venous indwelling needle through sacral canal combined with continuous intravenous sedation with propofol in infants operations below the navel.Methods 40 infants at the age of 5 months to 3 years who underwent operations below the navel were randomly divided into 2 groups: the auxiliary group of continuous caudal anesthesia combined with propofol(Group A) and the group of intravenous general anesthesia with ketamine in combination with propofol(Group B).After the basal anesthesia,venous indwelling needle was fixed by adhesive plaster after the sacral canal puncture,and then continuous blockade was conducted by 0.8%~1.2% lidocaine combined with intravenous sedation with 4~6 mg/(kgoh) of propofol in Group A;while the mixed liquor of ketamine and propofol(1:1) was continuously injected by micro-pump according to the standard of 30~50μg/(kgomin) of ketamine in Goup B.The blood pressure(BP),heart rate(HR),respiration(R),oxygen saturation(SpO2),recovery time and complications were recorded before and after anesthesia induction,at skin incision,in and after operation in these two groups of infant patients.Results There were significant differences between the two groups in BP and HR after the anesthesia induction,at skin incision,in and after operation,and the value of BP and HR in Group A were lower than those in Group B(p<0.05);meanwhile the recovery time was shorter and complications were obviously less in Group A than those in Group B(P<0.01).Conclusion Continuous caudal anesthesia by venous indwelling needle combined with propofol sedation in infants who underwent operations below the navel is effective,safe,and reliable with low dose of anesthetic drug and short recovery time,which deserves promotion and recommendation.