摘要
目的探讨不同剂量顺式苯磺酸阿曲库铵与呼吸机辅助用于小儿气管异物取出术麻醉处理的效果。方法选择收治的132例行气管异物取出术治疗的患儿,随机分为A、B、C、D四组,各33例。所有患儿入室后均给予8%七氟烷诱导,静脉缓推0.01 mg·kg^(-1)咪达唑仑、2 mg·kg^(-1)丙泊酚、0.2μg·kg^(-1)舒芬太尼。在此基础上,A、B、C组诱导麻醉时分别给予0.15、0.2、0.3 mg·kg^(-1)顺式苯磺酸阿曲库铵静脉泵入,D组给予静脉泵入0.15 mg·kg^(-1)生理盐水,均以呼吸机辅助呼吸并以静脉泵入10 mg·kg^(-1)·h^(-1)丙泊酚,七氟烷持续吸入维持。待脑电双频指数(BIS值)降至40左右时,置入硬性支气管镜,SICU室监测体征后转入普通病房。比较四组患儿置镜满意率、不同时间点各体征指标变化情况、恢复时间、术中不良反应发生率,同时观察A、B、C三组不同时点肌松程度。结果 A、B、C三组置管满意率组间比较差异无统计学意义(P>0.05),以上三组与D组比较满意率均显著较高(P<0.05);四组血氧饱和度(SpO_2)、心率(HR)、收缩压(SBP)组内各时点及组间比较差异均无统计学意义(P>0.05);A、B、C三组起效时间比较差异有统计学意义(P<0.05),表现为剂量越高,起效时间越短,三组术中最低值、气管插管时、置入硬性支气管镜时第一个肌颤搐(T1)值及拔管时4个成串刺激(TOF)值比较差异无统计学意义(P>0.05);A→B→C→D组麻醉至气管插管时间、停药至自主呼吸恢复时间、睁眼时间、拔管时间呈现递增趋势,A组患儿恢复情况最佳;C组术中不良反应发生率最低,但与A、B组比较差异无统计学意义(P>0.05),A、B、C组术中不良反应发生率均显著低于D组,差异有统计学意义(P<0.05)。结论顺式苯磺酸阿曲库铵联合呼吸机辅助是一种小儿气管异物取出术麻醉的良好选择,小剂量顺式苯磺酸阿曲库铵可基本满足小儿气管异物取出术的肌松需要,可使恢复时间缩短,临床应用可行。
Objective To investigate the effect of different doses of cisatracurium besilate and assisted ventilator applied in the anesthe-sia management of operation for children with tracheal foreign body. Methods A total of 132 children undergoing operation of tracheal foreign bodies between January 2014 and May 2016 were randomized into group A,group B,group C and group D,33 cases in each. All children were given 8% sevoflurane induction,intravenous slow injection of 0. 01 mg·kg - 1 midazolam,2 mg·kg - 1 propofol,0. 2 μg· kg - 1 sufentanil after entering the operating room. On the basis,group A,group B and group C were respectively treated with intravenous injection of 0. 15,0. 2 and 0. 3 mg·kg - 1 cisatracurium besilate during anaesthesia induction. Group D was treated with intravenous in-fusion of 0. 15mg·kg - 1 normal saline. All children breathed with assist of ventilator and were treated with intravenous infusion of propofol at 10 mg·kg - 1 ·h - 1 ,maintaining with continuous inhalation of sevoflurane. When the bispectral index （BIS value） was re-duced to about 40,the rigid bronchoscope was implanted. After monitoring of signs in SICU,the children were transferred to the general wards. The satisfaction with implantation of bronchoscope,changes of signs at different time points,recovery time and the incidence of adverse reactions during operation were compared between the four groups. Meanwhile,the degree of muscle relaxation in group A,group B and group Cwasobserved at different time points. Results There was no significant difference in satisfaction with implantation of bronchoscope between group A,group B and group C （P 〉 0. 05）. The satisfaction rates in the above three groups were significantly higher than that in group D （P 〈 0. 05）. There were no significant differences in SpO2 ,HR and SBP within group between different time points and between groups （P 〉 0. 05）. There was significant difference in onset time between the three groups （P ＆lt; 0. 05）,showing that the higher the dose was,the shorter the onset time was. There were no significant differences in intraoperative minimum value,T1 values on tracheal intubation and when the rigid bronchoscope was implanted and TOF value on extubation （P 〉 0. 05）. For group A→B→C→D,the time from anesthesia to tracheal intubation,time from drug withdrawal to spontaneous breathing recovery,time to eye o-pening and extubation time showed an increasing trend. Children in group A recovered best. The incidence of adverse reactions was the lowest in group C,but there was no significant difference,compared with group A and group B （P 〉 0. 05）. The incidence of adverse re-actions in group A,group B and group C was significantly lower than that in group D （P ＆lt; 0. 05）. Conclusions Cisatracurium besilate and assisted ventilator is a good choice for anesthesia of operation for children with tracheal foreign bodies. Low-dose cisatracurium besi-late can basically meet the muscle relaxation need of children with tracheal foreign bodies,so that shorter recovery time. It is feasible for clinical application.
出处
《安徽医药》
CAS
2017年第11期2089-2093,共5页
Anhui Medical and Pharmaceutical Journal
关键词
小儿气管异物
顺式苯磺酸阿曲库铵
呼吸机辅助
麻醉效果
Children with tracheal foreign body
Cisatracurium besilate
Ventilator assisted
Anesthesia effect
