蔡少英+张晓伟

【摘要】 目的：探討七氟烷复合骶管阻滞麻醉在小儿下腹部手术中的应用效果。方法：选择2014年1月-2015年12月本院100例行外科手术的小儿患者，按照麻醉方法的不同分为观察组和对照组，各50例。对照组采用氯胺酮复合骶管阻滞麻醉，观察组采用七氟烷复合骶管阻滞麻醉，观察并比较两组麻醉效果。结果：观察组麻醉后、术中、术毕时血压与心率水平与麻醉前比较，均未见明显波动，差异均无统计学意义（P>0.05）；而对照组麻醉后、术中、术毕时血压与心率水平均较麻醉前明显提高，差异均有统计学意义（P<0.05）；观察组围术期的血压、心率水平与对照组比较，均更平稳（P<0.05）。观察组的优良率为96.0%，明显高于对照组的80.0%，差异有统计学意义（P<0.05）。观察组不良反应发生率为4.0%，明显低于对照组的18.0%，差异有统计学意义（P<0.05）。观察组患儿清醒时间较对照组明显缩短，差异有统计学意义（P<0.05）。结论：七氟烷复合骶管阻滞麻醉患儿的呼吸、循环系统更加平稳，且安全性较高，优于传统的氯胺酮复合骶管阻滞麻醉。

【关键词】 小儿； 七氟烷； 氯胺酮； 复合麻醉； 骶管阻滞

【Abstract】 Objective：To investigate the effect of Sevoflurane combined with sacral block anesthesia in pediatric abdominal surgery.Method：100 pediatric patients underwent surgical operation in our hospital from January 2014 to December 2015 were selected as research objects.They were divided into the observation group and the control group according to the methods of anesthesia，50 cases in each group.Ketamine combined with sacral anesthesia were used in the control group，Sevoflurane combined with sacral block anesthesia were used in the observation group，observed and compared the effects of the two groups of anesthesia.Result：The blood pressure and heart rate after anesthesia，during and after operation in the observation group had no obvious fluctuations，compared with those before anesthesia，the differences were no statistically significant（P>0.05）；while the blood pressure and heart rate after anesthesia，during and after operation in control group were significantly improved，compared with those before anesthesia，the differences were statistically significant（P<0.05）；the blood pressure and heart rate before operation in the observation group were more stable compared with those in control group，the differences were statistically significant（P<0.05）.The excellent rate of observation group was 96.0%，significantly higher than 80.0% in control group，the difference was statistically significant（P<0.05）.The incidence of adverse reactions in observation group was 4.0%，significantly lower than 18.0% in control group，the difference was statistically significant（P<0.05）.The consciousness time in observation group was significantly shorter than that in control group，the difference was statistically significant（P<0.05）.Conclusion：Sevoflurane combined with caudal block anesthesia in children with respiratory，circulatory system more stable，and higher safety，better than the traditional Ketamine combined caudal block anesthesia.

【Key words】 Children； Seveoflurane； Ketamine； Combined anesthesia； Caudal blockendprint

First-authors address：Shangrao Peoples Hospital，Shangrao 334000，China

doi：10.3969/j.issn.1674-4985.2016.36.011

小儿下腹部手术既往多采用氯胺酮复合骶管阻滞麻醉下完成，在长期临床实践发现，氯胺酮复合骶管阻滞麻醉下，患儿多会出现心肺功能不稳定、呼吸抑制、苏醒延迟、复睡等不良反应，在一定程度上增加了手术的风险性[1-2]。七氟烷是吸入型麻醉剂，无色透明，七氟烷血/气分配系数低，麻醉诱导迅速，不会对患儿呼吸、循环系统造成严重影响，维持平稳，麻醉深度容易调节，目前在小儿临床麻醉中的应用越来越广泛[3-4]。本文对本院采用七氟烷复合骶管阻滞麻醉在小儿下腹部手术中的应用效果进行回顾性分析，现报告如下。

1 资料与方法

1.1 一般资料 选择2014年1月-2015年12月本院100例行外科手术的小儿患者，按照麻醉方法的不同分为观察组和对照组，各50例。观察组男33例，女17例，年龄7个月～6岁，平均（3.3±1.5）岁；体重6～38 kg，平均（24.9±10.9）kg；ASA分级：Ⅰ～Ⅱ级；手术……