七氟烷低流量维持麻醉在儿童择期手术中的应用

【目的】观察七氟烷低流量维持麻醉对行择期手术儿童的血流动力学、肝肾功能与血气指标的影响，并评估其安全性和可行性。【方法】选择在全麻插管下行择期手术（手术时间2～4 h）的3～12岁儿童40例，ASA分级Ⅱ～Ⅲ级，随机分为 A（低流量组）、B（中等流量组）两组（n＝20）。两组诱导均采用静脉快速诱导，氧流量2 L/min，面罩加压给氧。气管插管后七氟烷挥发罐调至3％，A 组氧流量调至0．5 L/min，B 组氧流量调至2．5 L/min。监测所有患者的心率（HR）、平均动脉压（MAP）、呼气末二氧化碳分压（PET CO2）以及脉搏血氧饱和度（SpO2）。记录插管后10 min（T0）、插管后1 h（T1）、插管后2 h（T2）及术毕（T3）的 HR、MAP、PETCO2及SpO2，并抽取各时点桡动脉血行血气分析。术前及术后24 h抽静脉血监测肝肾功能。【结果】A、B两组患者组间和组内各监测点的 HR、MAP、PETCO2、SpO2及动脉血气指标相比较差异无显著性（P ＞0．05）。两组患者手术前后肝肾功能指标组间及组内对比无明显差异（P＞0．05）。整个手术过程中两组患者均无低氧血症及高碳酸血症发生。【结论】七氟烷低流量新鲜气体使用0．5 L/min氧流量麻醉维持方案对3～12岁行择期手术儿童肝肾的功能无明显影响，血流动力学、动脉血气指标监测在正常范围，可安全用于儿童的择期手术麻醉。

Application of Sevoflurane Low-flow Maintenance Anesthesia in the Elective Surgery of Children

Obj ective]To observe the effect of sevoflurane low-flow maintenance anesthesia on the hemodynamics,hepat-ic and renal function and blood gas index of children undergoing elective surgery,and to assess the safety and feasibility.Methods]A total of 40 ASAⅡorⅢchildren undergoing elective surgery with tracheal intubation under general anesthesia （operation time of 2～4h）were chosen and randomly divided into group A（low-flow group,n=20）and group B（middle-flow group,n=20）.Both two groups were given rapid venous induction with oxygen flow at 2L/min,and then oxygen supply by face mask compression.After tracheal intubation,sevoflurane volatilizing j ar was regulated to 3%.Oxygen flow in group A and group B was 0.5L/min and 2.5L/min respectively.Heart rate（HR）,blood pressure（MAP）,PET CO2 and SpO2 of all pa-tients were monitored.HR,MAP,PET CO2 and SpO2 at 10min after intubation（T0 ）,1h after intubation（T1 ）,2h after intu-bation（T2 ）and the end of operation（T3 ）were recorded.Radial arterial blood at each time points was drawn to gas analysis. Venous blood before and 24h after operation were drawn to monitor hepatic and renal function.Results]There was no sig-nificant difference in HR,MAP,PET CO2 ,SpO2 and arterial gas analysis index at each checking point between group A and group B（P＆gt;0.05）.There was no significant difference in hepatic and renal function indicators before and after operation between two groups（P〉0.05）.No hypoxemia and hypercarbia occurred during the whole procedure in both groups.Con-clusion]Sevoflurane low-flow fresh gas with oxygen flow at 0.5L/min for maintenance anesthesia has no obvious influence on hepatic and renal function in children undergoing elective surgery,and the hemodynamics and arterial gas indexes are in nor-mal range.Therefore,it is safe in elective surgical anesthesia of children.