摘要
目的儿童阻塞性睡眠呼吸暂停低通气综合征(OSAHS)的气道管理较为复杂,本研究拟寻找一种安全、有效的麻醉诱导方式。方法随机选择OSAHS患儿160例分两组,手术方式为双侧扁桃体切除加腺样体吸割。静脉麻醉诱导后当BIS监测达50%时,A组,声门外1%地卡因喷雾,充分弥漫后静注维库溴胺0.1mg/kg;B组,静注维库溴胺0.1mg/kg。气管插管评分后,麻醉医师插入喉镜,完成气管插管。另外分别在基础值(T1),插管后2min(T2),插管后5 min(T3),插管后10min(T4)监测并记录血流动力学参数(BP、MAP、HR)和BIS值,采集静脉血测定血糖。计算心率收缩压乘积(RPP)。记录手术结束到苏醒时间(唤之能醒,睫毛反射)。结果在麻醉诱导期间两组患儿气管插管评分比较差异均无统计学意义。A组较B组明显缩短麻醉诱导到插管时间。麻醉诱导后B组2min HR较基础值有显著增快。麻醉诱导后2min RPP较基础值有显著增高。其余各时段与基础值相比较差异均无统计学意义。两组患儿没有发生心率降低和低血压。结论麻醉诱导辅以局麻浸润插管可以提供令人满意的插管条件,并且血流动力学反应平稳,应激反应小,缩短了麻醉诱导时间,减少了麻醉并发症的发生,值得推广应用。
Objective To find a safe and effective induction mode of anesthesia in pediatric obstructive sleep apnea hypoventilation syndrome （ OSAHS）. Methods 160 OSAHS children for selective bilateral tonsillectomy and adenoidectomy were divided into two groups randomly. After intravenous anesthetic induction and when BIS was 50% , children in group Ⅰ were sprayed with 1% dicaine supraglotticly,and 0. 1 mg/kg vecuronium was injected intravenously following after local anesthetic diffusion thoroughly. The children in group Ⅱ were injected with vecuronium 0.1 mg/kg. After the intubation score was evaluated, the anesthetist intubated. The haemodynamic parameters （BP/MAP/HR） and BIS at T1 （ base line） , T2 （ 2 min after intubation） , T3 （ 5 rnin after intubation） , T4 （ 10 min after intubation ） were recorded, and venous blood was collected for determination of serum glucose. Rate - pressure product （RPP） was calculated. The time from operation ending to emergence （ according to the lash reflex and arousal response） was recorded. Results There was no significant difference in intubation score between two groups. The time from induction of anesthesia to intubation was shorted significantly in group Ⅰ than that in group Ⅱ. In group Ⅱ ,the heart rate at 2nd rain after induction was much faster than the base line. RPP at 2nd min after intubation was greater than the base line. There was no significant difference between the values at other time points and the base line. No decreases in heart rate and blood pressure occurred in two groups. Conclusion Anesthetic induction with local anesthetic spraying can provide satisfied intubation condition. The haemodynamic reaction is stable and the stress reaction is mild. It can shorten the induction time and decrease the anesthetic complication.
出处
《临床外科杂志》
2008年第8期555-557,共3页
Journal of Clinical Surgery
