不同麻醉方法在小儿腹腔镜手术中的应用体会

目的:对比分析不同麻醉方法对小儿腹腔镜手术患者插管及拔管前后心率、并发症情况的影响。方法:随机将56例腹腔镜手术患儿分为骶管复合气管插管全麻组(A组)、骶管复合喉罩全麻组(B组)、单纯喉罩全麻组(C组)、单纯气管插管全麻组(D组),每组14例。患儿10个月~5岁,体重9.5~21 kg。分别于麻醉插管后即刻、拔管前1 min、拔管后即刻记录心率变化,观察拔管时有无喉痉挛、呼吸道分泌物情况,术中记录心率、血氧饱和度、呼气末二氧化碳分压及BIS值。术后2 h内观察有无咽喉部疼痛不适、声音嘶哑、哭闹、咳嗽、呼吸异常及意识恢复情况。结果:B组插管后即刻、拔管后即刻对心率的影响较其他三组小,患儿术后清醒时咽喉部疼痛、咳嗽、喉痉挛、呼吸道分泌物明显减少,耐受的BIS指数更高。拔除喉罩患儿呼吸更平稳、清醒更彻底。结论:小儿腹腔镜手术行骶管复合喉罩全麻患儿麻醉前后心率的变化波动较小,术后患儿清醒更彻底,并发症更少。

Experience of different anesthesia methods during the surgical laparoscopic surgery in children

Objective：To compare and analyze the effect of different anesthesia methods during pediatric surgical laparoscopic operation on heart rate and complications before and after intubation or extubation.Methods：Laparoscopic operation in 56 cases,were randomly divided into sacral canal composite tracheal intubation in general anesthesia group（group A）,sacral canal combined with laryngeal mask airway in general anesthesia group（group B）,simple laryngeal mask anesthesia group（group C）,simple tracheal intubation general anesthesia group（group D）.Each group has 14 cases（age：10 months-5 years,weight：9.5-21 kg）.Clinical observation on the anesthetic intubation were immediately after extubation,1 minutes before and immediately after extubation respectively.After recording heart rate changes,laryngeal spasm,respiratory secretions,intraoperative recording of heart rate,oxygen saturation,end-tidal carbon dioxide tension and BIS value were detected.Throat pain,hoarseness,crying,cough,respiratory abnormalities and consciousness recovery were observed within 2 h postoperatively.Results：the effect of immediately after extubation and immediately after extubation in Group B on the heart rate was less than that in group A,group C,group D.The incidence of children＇ postoperative awake throat pain,cough laryngospasm and respiratory secretion was markedly reduced in B group with a higher BIS index.Children＇ breathing is more stable and analepsis is better after removal of laryngeal mask airway in B group.Conclusions：Caudal and laryngeal mask anesthesia during pediatric laparoscopic operation induces milder heart rate fluctuation before and after anesthesia and children have better awake and fewer complications.