硬膜外阻滞辅以全麻在小儿手术治疗中的应用
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【中图分类号】R614.2【文献标识码】A【文章编号】1672-6383-(2010)12-0067-02
【摘要】目的：本文对我院自2007年8月至2010年8月在硬膜外阻滞辅以全麻用于小儿手术的临床效果进行总结。方法：30例手术患儿随机分为单纯全麻I组和硬膜外辅以全麻Ⅱ组，每组15例。观察两组病人循环功能的改变、术中全麻药的用量、手术部位肌松程度及术毕清醒时间。结果：两组病人一般情况、手术时间无明显差异(P>0.05)。血压、心率于术前、术中、术毕清醒时有明显差异(P<0.05)。苏醒时间组间相比有明显差异性(P<0.01)，术中麻醉用药两组间有明显差异(P<0.01)，手术部位肌松程度有明显差异。结论：硬膜外阻滞辅以全麻用于小儿手术患儿循环系统更平稳、全麻用药量小，患儿苏醒快，肌松程度更满意。
【关键词】硬膜外阻滞；全麻；小儿
Outside the hard membrane hinders auxiliary by the general anesthesia， in the young child surgery treats the application
Wei Qimei
【Abstract】Objective：This article -2010 year in August hinders to my courtyard from August， 2007 outside the hard membrane auxiliary to use in the young child surgery's clinical effect by the general anesthesia carrying on the summary. Method： 30 example surgery baby divides into the pure general anesthesia I group stochastically with the hard membrane outside auxiliary by the general anesthesiaⅡGroup， each group of 15 examples. Observes two group of patient loop function in the change， the technique the entire anesthetic amount used， the surgery spot myo- loose degree and the technique finishes the sober time. Finally： Two group of patient ordinary circumstances， surgery time not obvious difference (P>0.05). The blood pressure， the heart rate in the technique， the technique， the technique finish is sober when have the obvious difference(P<0.05)。The regaining consciousness time group compares has the obvious difference (P<0.O1)，In the technique anaesthetizes applies drugs during two groups to have the obvious difference(P<0.O1)，The surgery spot myo- loose degree has the obvious difference. Conclusion： Outside the hard membrane hinders auxiliary to use in the young child surgery baby circulatory system by the general anesthesia being steadier， the general anesthesia to be small with the dose， the baby regains consciousness quickly， the myo- loose degree is more satisfied.
【Keywords】 Outside the hard membrane hinders； General anesthesia； Young child1临床资料
1.1病例：全组30例，男18例、女12例，年龄3～12岁，体重11.5～30kg，ASA为I～Ⅱ级。腹腔镜下阑尾切除术10例， 鞘膜积液翻转术6例，经腹斜疝高位结扎术6例，下肢手术4例，开腹阑尾切除术2例，腹腔镜下斜疝高位结扎术2例。
1.2麻醉方法：患儿入手术室后缓慢静脉注射氯胺酮1～2 mg/kg或肌肉注射氯胺酮5～7mg/kg，待神志消失后，Ⅱ组将患儿置于左侧卧位选用直入法行硬膜外腔穿刺，穿刺部位L1～L2间隙，穿刺成功确认无误后将2%利多卡因：0.75%布比卡因：生理盐水的1∶1∶1混合液按0.5～0.6ml/kg缓慢注入硬膜外腔，先注入预计总药量的1/4为试验量，观察5min无异常，再缓慢注入余药量。手术开始给一次氯胺酮1～2mg/kg，丙泊酚2mg/kg作为首量麻药，术中泵注丙泊酚维持镇静，观察患儿反应间断静脉注射氯胺酮，I组除未行硬膜外阻滞麻醉外，其他操作方法同Ⅱ组。
1.3观察项目与监测：手术中常规应用多功能监护仪监测SBP、DBP、MAP、HR及SaO2，分别记录两组病人术前、切皮、术中、术毕苏醒时的血压、心率以及术毕清醒所需时间、注药间隔时间及静脉麻药用药总量、术中肌肉松弛情况。
1.4 统计学分析：所有数据用均数±标准差(χ±s)表示。应用SPSS12.0统计分析软件进行统计学处理。组间数据及组内数据的比较采用成组和配对t检验 ......
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