七氟醚吸入麻醉用于婴儿唇裂修复术的临床观察

目的比较七氟醚吸入麻醉与氯胺酮全凭静脉麻醉在婴儿唇裂手术中的应用效果,评估七氟醚吸入麻醉在婴儿唇裂修复术中的临床价值。方法80例唇腭裂患儿,ASAⅠ-Ⅱ,年龄3-10月,随机分为七氟醚组和氯胺酮组。七氟醚组以7%七氟醚＋氧气3 L/min面罩吸入诱导;氯胺酮组静脉注射氯胺酮2.5 mg/kg诱导。患儿入睡后2组分别静脉注射芬太尼2μg/kg,维库溴铵0.1 mg/kg,经口气管插管接麻醉机控制呼吸。七氟醚组持续吸入1%-3%七氟醚,氯胺酮组分单次追加氯胺酮1 mg/kg。2组术中各追加1次芬太尼1μg/kg。记录诱导和苏醒时间;诱导前、诱导后、气管插管后、术中及拔管后的脉搏氧饱和度（SpO2）、心率（HR）、平均动脉压（MAP）、呼气末二氧化碳分压（PetCO2）。全程观察有无咳嗽、屏气、喉痉挛、分泌物增加,术后躁动或嗜睡的发生。结果2组麻醉诱导时间无明显差异（P〉0.05）,苏醒时间七氟醚组明显短于氯胺酮组（P〈0.01）。七氟醚组诱导后HR明显慢于氯胺酮组（P〈0.01）,MAP低于氯胺酮组（P〈0.01）。氯胺酮组的不良反应明显高于七氟醚组（P〈0.01）。结论七氟醚应用于婴幼儿麻醉诱导迅速、苏醒快、无术后躁动和嗜睡现象，对血流动力学影响小，且麻醉效果好，安全可控，明显优于氯胺酮静脉麻醉。

Clinical Study on Inhalation Anesthesia with Sevoflurane in Infant Cleft Lip Repair Surgery

Objective To make a comparison between the effect of inhalation anesthesia with sevoflurane and that of intravenous anaesthesia induced with ketamine in infant cleft lip repair surgery,and to assess the clinical value of inhalation anesthesia with sevoflurane in the surgery. Methods Eighty patients with cleft lip and palate,American Society Anesthesiologists（ASA）Ⅰ～Ⅱ,aged 3～10 months,were randomized into two groups（n=40 each） ： sevoflurane group and ketamine group.In sevoflurane group,anesthesia was induced with sevoflurane （7%） and oxygen （3 L/min）, while in ketamine group,ketamine （2. 5 mg/kg） was intravenously injected. After induction, anesthesia of the two groups was maintained by fentanyl（ 2 μg/kg ） and vecuronium （0.1 mg/kg）, and their respiration was controlled via anesthesia machine after endotracheal intubation. Sevoflurane group was continuously exposed to 1%- 3 % sevoflurane, and ketamine group was administered additional ketamine （1 mg/kg） each time. The two groups were respectively given additional fentanyl （1 μg/kg） for another time during the operation. The induction time and analepsia time were recorded. The mean arterial blood press （MAP）,heart rate （HR） , oxygen saturation （SpO2） and end--tidal carbon dioxide tension （PetCO2） were measured immediately before and after induction , during operation , before and after endotracheal intubation. The side effects during anesthesia such as irritating cough, holding breathlessness, laryngeal spasm,increased secretion, rest- lessness or somnolence were noted. Results There were not significant differences in the induction time between the two groups（P〉0.05）, but the analepsia time in sevoflurane group was obviously shorter than that in ketamine group （P〈0.01）. The heart rate and MAP were lower than those in ketamine group （P〈0.01 respectively）, while side effects in sevoflurane group were more severe compared with those in ket- amine group （P〈0.01）. Conclusion Inhalati