学龄前儿童腹股沟斜疝手术不同麻醉方法的选择

目的观察3种不同麻醉方法用于学龄前儿童腹股沟斜疝手术的麻醉效果。方法选择4~6岁行腹股沟斜疝手术的患儿60例,美国麻醉师协会(ASA)Ⅰ级。先肌注氯胺酮5 mg/kg,入睡后开通静脉,然后随机均分为3组。A组:由同一麻醉医师行骶麻,用微泵输注丙泊酚维持麻醉,手术开始时追加氯胺酮1 mg/kg;B组:由同一术者行局部麻醉,用微泵输注丙泊酚维持麻醉,局麻开始时追加氯胺酮1mg/kg;C组:单纯用微泵输注丙泊酚加氯胺酮维持麻醉。观察术中平均动脉压(MAP)、心率(HR)的变化,丙泊酚和氯胺酮的用量,术毕清醒时间和躁动评分以及术后恶心、呕吐等并发症。结果 3组术中的MAP、HR变化组间、组内对比无统计学意义(P>0.05),A、B组的丙泊酚和氯胺酮用量比C组少(P<0.05);术毕清醒时间比C组短(P<0.01);躁动评分比C组低(P<0.01);而A、B组无差异(P>0.05);3组术后恶心、呕吐的发生率差异无统计学意义(P>0.05)。结论 3种麻醉方法均可安全用于学龄前儿童腹股沟斜疝手术,但以B组操作更简单,安全性更高,医疗费用低,更值得临床选用。

The choice of different anaesthesia methods for operation of oblique inguinal hernia in preschool children

Objective To observe the anesthetic effect of three different kinds of anaesthesia methods for operation of oblique inguinal hernia in preschool children. Methods Sixty cases of 4 - 6 years old children with operation for oblique inguinal hernia （ASA I ） had been chosen for study, all of them were equally divided into three groups, and their veins were put into operation after intramuscular injection of ketamine （5 mg/kg）. In group A, children were anesthetized on pars sacralis by the same anesthetist, anesthesia was maintained by infusion of prepofol with minipump, and boosted ketamine （1 mg/kg） at the beginning of operation. In group B, anesthesia was maintained by infusion of propofol with minipump, and boosted ketamine （ 1 mg/kg） before the local anesthesia had been chosen by the same operator. In group C, anesthesia was simply maintained by infusion of propofol and ketamine with minipump. The changes of MAP and HR, dosage of prepofol and ketamine, restlessness SCOreS recovery time and complications after operation were observed. Results There was no statistically significant difference in changes of MAP and HR in three groups with intergroup and intragroup contrast （ P 〉 0. 05 ）. The dosage of propofol and ketamine, restlessness recovery time in group A and B were lower than those of group C （ P 〈 0.05 ）, while the difference between groups A and B was not statistically significant. The difference in incidence rates of postoperative nausea and emesia was not statistically significant among three groups. Conclusion All anaesthesia methods are used with safety, and the procedure in group B is simple with high safety and low charge, and it deserves to be clinical adoption.