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目的探讨七氟烷喉罩吸入辅助神经阻滞麻醉在儿童短小手术中的应用,评价其安全性和可行性。方法选择60例择期四肢及下腹部手术患儿,术前七氟烷面罩吸入至意识消失,下腹部及下肢手术第3~4腰椎间隙腰麻穿刺成功后注入0.894%罗哌卡因0.8~2.0 ml,上肢手术肌间沟入路臂丛阻滞注入利多卡因和罗哌卡因1∶1混合液5~15 ml,加深吸入七氟烷置入喉罩,保留自主呼吸,手术开始。麻醉维持应用单纯1.7%~2.4%七氟烷喉罩吸入辅助神经阻滞麻醉。手术结束前5 min停止吸入麻醉气体,患者清醒后拔出喉罩。观察患儿术中强刺激引起的摇头肢体活动、脉搏氧饱和度(SpO2)<95%情况,记录切皮后、手术开始后20 min、手术结束前10 min时3个时间点血流动力学[平均动脉压(MAP)、心率(HR)]变化。结果 60例患儿术中无一例强刺激引起的摇头肢体活动;SpO2<95%3例;切皮、手术开始后20 min、手术结束前10 min 3个时间点MAP、HR比较差异无统计学意义(P>0.05)。结论七氟烷喉罩吸入辅助神经阻滞麻醉在儿童短小手术中的应用血流动力学稳定性且安全可行。
Objective To investigate the application of inhalation of sevoflurane laryngeal mask anesthesia in short operation of children and evaluate its safety and feasibility. Methods Sixty children with elective extremities and lower abdomen surgery were enrolled in this study. Preoperative sevoflurane mask was inhaled to consciousness disappear. After successful operation of lower abdomen and lower extremities, lumbar puncture of the 3rd to 4th lumbar intervertebral space was injected with 0.894% ropivacaine 0.8-2.0 ml, upper limb surgery interosseous approach brachial plexus injection of lidocaine and ropivacaine 1: 1 mixture of 5 ~ 15 ml, deepen the inhalation of sevoflurane into the laryngeal mask, to maintain spontaneous breathing, the operation began. Anesthesia maintenance application of simple 1.7% to 2.4% sevoflurane laryngeal mask inhalation assisted nerve block anesthesia. 5min before the end of surgery to stop inhalation of anesthetic gas, the patient swoop out the laryngeal mask. Hemodynamic changes were observed in patients with moderate to severe physical shock. The pulse oxygen saturation (SpO2) <95% was recorded. The hemodynamics were recorded 20 minutes after the start of operation and 10 minutes before the end of operation [Mean arterial pressure (MAP), heart rate (HR)] changes. RESULTS: There was no significant difference in MAP and HR between the 60 patients and the control group (SpO2 <95%) in 3 cases. The incision time was 20 min after the operation and 10 min before the operation Significance (P> 0.05). Conclusion The application of sevoflurane laryngeal mask inhalation anesthesia in short-term surgery in children with hemodynamic stability and safety feasible.