插管保留自主呼吸的复合麻醉在小儿唇腭裂手术中的可行性研究(1)
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【摘要】 目的：探讨插管保留自主呼吸的复合麻醉在小儿唇腭裂手术中的可行性。方法：随机选择唇腭裂残疾患儿80例，分A、B两组麻醉。A组以氯胺酮诱导，七氟醚吸入等静吸复合全麻的方法。插管用肌松药，术中控制呼吸。B组采用以七氟醚诱导维持，另加局部麻醉，辅以少量芬太尼并肛纳对乙酰氨基酚栓等联合镇痛，插管不用肌松药，保留自主呼吸。结果：B组患儿完全清醒和气管拨管时间明显早于A组(P<0.05)，且该组术后并发症的发生率也明显低于A组(P<0.01)。结论：插管保留自主呼吸的复合麻醉在小儿唇腭裂手术中安全可靠，术中血流动力学稳定。术毕患儿清醒快，气管导管拔除早，术后并发症少。
【关键词】 插管； 自主呼吸； 复合麻醉； 小儿； 唇腭裂手术
The Feasibility of Children Cleft Lip and Palate Cleft Repair under Balanced Combined Anesthesia With Endotracheal Intubation and Autonomous Respiration/CAI Jian-bo， LAI Wei-rong， WU Li-Fen.//Medical Innovation of China，2012，9(12):021-022
【Abstract】 Objective: To study the feasibility of children cleft lip and palate cleft repair under balanced combined anesthesia with endotracheal intubation and autonomous respiration. Methods: Eighty children who received cleft lip or palate cleft were divided into group A and group B randomly， and 40 cases in each group. Group A was treated by sevoflurane and ketamine anaesthesia. Children intravenoused muscle relaxants and were controled respiration. Group B was treated by intravenous Fentanyl 1 μg/kg， meantmie Sevoflorane mask inhalation anaesthesia 6% ~8% sevoflurane， when consciousness and pain relief insert endotracheal tube. After induction， the surgeon made the local anaesthesia at the nerve of hypoorbital. And their anus was pushed into analgesic paracetamol supposeitories. All the children breathed spontaneously during operation. The anaesthesia was maintained with 2%-3% sevoflurane. The children didn't use muscle relaxants and ketamine. Results: The time to be awaken and the time to extubation in group B was shorter than that in group A. The records of nausea， vomiting， asphyxia， and laryngospasm in group B were less than those in group A. Conclusion: General anesthesia with autonomous respiration can be used for cleft lip repair in infants， and rapid anaesthesia little side effect.
【Key words】 Balanced Combined Anesthesia； Intubated； Autonomous Respiration； Children； Cleft lip and palate cleft
First-author’s address: Huiyang People’s Hospital of Huizhou， Huizhou 516211 ......
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