骶管阻滞复合咪达唑仑在小儿会阴部手术中的应用

目的探讨骶管阻滞复合咪达唑仑静脉输注在小儿会阴部手术的临床效果和安全性。方法选择行会阴部手术患儿60例,随机分为两组,骶管阻滞组(Ⅰ组)和氯胺酮静脉全麻组(Ⅱ组),每组各30例。Ⅰ组应用骶管阻滞复合咪达唑仑静脉全麻,Ⅱ组应用氯胺酮静脉全麻。记录患者麻醉诱导前、麻醉后10min、切皮时、术中10min、手术结束时及手术结束30min的平均动脉压(MAP)、心率(HR)、呼吸频率(RR)和脉搏血氧饱和度(SpO2),并记录两组发生不良反应病例数及苏醒时间。结果Ⅰ组麻醉诱导后各时点的MAP、HR、RR、SpO2与麻醉诱导前比较差异无统计学意义(P>0.05)。Ⅱ组麻醉诱导后各时点的MAP、HR显著升高(P<0.05),RR、SpO2显著降低(P<0.05)。Ⅰ组苏醒时间比Ⅱ组短(P<0.05)。Ⅰ组发生不自主肢动、呼吸抑制、躁动、呕吐等不良反应比Ⅱ组少(P<0.05)。结论骶管阻滞复合咪达唑仑静脉全麻应用于小儿会阴部手术临床效果确切,呼吸、循环稳定,苏醒时间短,不良反应少,是一种较理想的麻醉方法。

The Clinical Application of Caudal Block combined with Midazolam Intravenous Anesthesia in Pediatric Perineal Surgery

Objective To study the efficacy and safety of caudal block combined with intravenous infusion of midazolam in pediatric perineal surgery.Methods A total of 60 pediatric patients undergoing perineal surgery were divided randomly into two groups,caudal block group（group Ⅰ） and ketamine intravenous anesthesia group（group Ⅱ）,30 cases in each group.The patients of group Ⅰ received caudal anesthesia combined with midazolam intravenous general anesthesia,and group Ⅱ ketamine intravenous general anesthesia.Mean arterial pressure（MAP）,heart rate（HR）,respiratory rate（RR） and oxygen saturation（SpO2） were recorded before induction of anesthesia,10min after induction of anesthesia,at the time of skin incision,10min after the operation started,the end of surgery and 30min after the end of surgery,the number of cases which had adverse reactions and the recovery time of each patient also were recorded.Results No significant difference was observed in the MAP,HR,RR,SpO2 at different time points before and after the induction of anesthesia in group Ⅰ（P 0.05）.Compared with pre-anesthesia,the MAP,HR increased significantly（P0.05） and RR,SpO2 was significantly lower（P0.05） at different time points after induction of anesthesia in group Ⅱ.The mean recovery time was significantly shorter in group Ⅰ than that in group Ⅱ（P0.05）.Involuntary body movement,respiratory depression,agitation,vomiting and other adverse reactions were occurred significantly less in group Ⅰ than those in group Ⅱ（P0.05）.Conclusion The clinical effect of caudal block combined with intravenous midazolam anesthesia in pediatric perineal surgery is effective and reliable,and is an ideal method of anesthesia with stable respiration and circulation,short recovery time and less adverse reactions.