两种麻醉方式用于小儿疝气手术的比较

目的探讨不同的麻醉方式用于小儿疝气手术效果。方法选择ASAⅠ-Ⅱ级、年龄10月-8岁、择期行疝气手术40例,随机分为2组,七氟烷吸入麻醉组（S组）和骶管阻滞组（C组）。入室后静脉给予0.1mg/kg咪唑安定、1mg/kg盐酸氯胺酮,S组给予面罩吸入七氟烷,根据血压、心率调节吸入麻醉药浓度;C组在左侧卧位下行单次骶管阻滞,穿刺成功后一次性骶管注入0.2%罗哌卡因1mL/kg。围麻醉期间连续观察SBP、DBP、HR、SpO2,记录手术结束后、清醒的时间及苏醒质量,记录患儿苏醒期并发症的发生数。结果两组患者在年龄、体重、性别方面无明显差异（P〉0.05）,麻醉时间和清醒时间有明显差别（P〈0.05）,两组在麻醉前血流动力学无明显差别,在手术开始时S组心率明显高于C组（P〈0.05）,在苏醒时及清醒时S组收缩压、舒张压及心率均明显高于C组（P〈0.05）,两组患者术中SpO2无明显变化,S组在苏醒期有30%患者出现屏气,SpO2〈90%,经面罩吸氧后能维持SpO2≥98%,50%患者出现恶心、呕吐,80%发生苏醒期躁动;而C组仅有5%患者出现屏气（P〈0.05）,10%患者出现恶心（P〈0.01）、呕吐,25%发生苏醒期躁动（P〈0.01）。其余不良反应如喉痉挛、低氧血症、呼吸抑制等两组均未发生。结论小儿骶管阻滞用于疝气手术围术期血流动力学平稳,术后躁动发生率低于七氟烷吸入组。

A comparison of two types of anesthesia for hernia surgery in children

【Objective】To study the effects of different types of anesthesia used for the pediatric hernia surgery.【Methods】40 Children with ASA I-Ⅱ level,the age of 10 months to 8 years old,undergoing hernia surgery,were randomLy divided into sevoflurane inhalation anesthesia group(S) and the caudal block group(C).All children were given 0.1 mg /kg midazolam of intravenous midazolam1 and 1mg/kg ketamine hydrochloride after intravenous.S-group was given the mask inhalation of sevoflurane,conditioning inhaled anesthetic concentrations according to blood pressure and heart rate;group C in the left lateral position downstream,disposable puncture after the success of single caudal block,0.2% ropivacaine 1mL/kg was injected to caudal.SBP,DBP,HR and SpO2 were continuous observation,The awake time and awakening quality,record the emergence of complications were recorded.【Resluts】There were no significant differences(P>0.05) in age,weight,gender.There were obvious difference(P<0.05) in anesthesia time and awake time.There was no significant differences in hemodynamic before anesthesia.In the beginning of operation the heart rate was significantly higher in S group than in group C(P<0.05).In the wake and awake,systolic blood pressure,diastolic blood pressure and heart rate were significantly higher in S group than group C(P<0.05).There were no significant change undergoing SpO2 in two groups.There was 30% patients with breath-hold in S group in the recovery and SpO2<90%,after oxygen mask the SpO2≥98% was maintained,50% of patients experienced nausea,and vomiting,80% with emergence agitation;group C only5% of children with breath holding(P<0.05),10% of children were nausea(P <0.01)and vomiting,and 25 % with emergence agitation(P<0.01).There were not occur in the remaining adverse events such as laryngospasm,hypoxemia,respiratory depression and other in two groups.【Conclusion】Pediatric sacral block for a hernia operation during perioperative period in children with stable hemodynamics,postoperative agitation rate was lower than seven halothane inhalation group.