髂筋膜间隙阻滞复合喉罩通气全麻在儿童股骨手术中的应用

目的 探讨髂筋膜间隙阻滞复合喉罩通气全麻在儿童股骨手术中的应用效果。 方法 选择嘉兴市妇幼保健院2014年5月-2015年6月收治的股骨干骨折择期手术儿童80例,按随机数字表法分为2组,每组40例,观察组(A组)行髂筋膜间隙阻滞+喉罩通气全身麻醉,对照组(B组)行气管插管全身麻醉。观察组气管插管后采用超声引导下髂筋膜间隙阻滞,2组均使用丙泊酚4~8 mg/(kg·h)复合浓度2%七氟烷麻醉维持,使BIS值维持在40~55之间、收缩压在基础值20%的范围内波动。记录2组喉罩或气管导管置入前后、切皮、术中血流动力学参数收缩压(SBP)、舒张压(DBP)和心率(HR)]变化,丙泊酚、舒芬太尼用量,拔管时间、离开恢复室时间。观察苏醒期躁动、术后咽喉疼痛及呼吸抑制等并发症的发生情况。采用视觉模拟评分(VAS)评价患者术后即刻、4 h、8 h、12 h、16 h及24 h的疼痛程度。 结果 置管后和术中2个时间点2组患者SBP、DBP和HR比较差异有统计学意义(均P<0.05),但麻醉前和手术结束时2组SBP、DBP和HR比较差异无统计学意义(均P>0.05)。术毕观察组舒芬太尼、丙泊酚用量较对照组明显减少;拔管时间和恢复室停留时间均明显短于对照组,2组比较差异有统计学意义(均P<0.05)。2组术后4~12 h组间VAS评分比较差异有统计学意义,术后12 h后组间VAS评分比较差异无统计学意义。观察组无髂筋膜间隙阻滞相关并发症发生,咽喉疼痛1例;对照组有2例患儿发生苏醒期躁动,咽喉疼痛4例,呼吸抑制1例,无其他并发症。 结论 在儿童股骨手术中,髂筋膜间隙阻滞复合喉罩通气全麻能够维持血流动力学平稳,减少全麻药及阿片类药物的用量,减少苏醒期躁动,缩短术后恢复时间,且术后镇痛效果良好。 

Clinical application of fascia iliaca compartment block combined with laryngeal mask airway in children undergoing femoral surgery

Objective To investigate the effects of fascia iliaca compartment block (FICB) combined with laryngeal mask airway in children undergoing femoral surgery. Methods Eighty children with femoral shaft fracture undergoing selective surgery were randomly divided into experiment group and control group (n=40). FICB combined with laryngeal mask airway were implemented into the experiment group, while general anesthesia with intubation was performed in the control group. After intubation, FICB was implemented under ultrasonic guidance in the experiment group. Anesthesia was maintained with propofol and sevoflurane to keep the bispectral index value between 45 and 55 and control the hemodynamic response to the surgical procedure within a 20% range of the preoperative value. Hemodynamic parameters were monitored, and postoperative pain was accessed by visual analogue scale within 24 hours and the requirements of propofol and sulfentanly were recorded. Postoperative complications were observed, such as time in Post Anesthesia Care Unit and time to extubation. Results Hemodynamic parameters in the experiment group were significantly higher than those in the control group (all P<0.05). The difference in VAS value for FICB was significant between the two groups at 4-12 h postoperatively (all P<0.05); when compared with control group, the dosage of propofol and sulfentanly was significantly less in the experiment group, and the time to extubation and time in postoperative anesthesia recover unit was shorter (all P<0.05). Additionally, the incidence of postoperative complication was less in the experiment group as compared with the control group. Conclusion FICB combined with laryngeal mask airway is superior to general anesthesia with intubation in children undergoing femoral surgery with less complications.