郭鑫+侯芝绮

【摘要】 目的 观察超快通道麻醉方法应用于小儿腹腔镜疝气手术的安全性和有效性。方法 60例拟在腹腔镜下行疝气手术的患儿作为研究对象， 随机分为超快通道麻醉组（U组）和常规麻醉组（G组）， 每组30例。U组患儿采用喉罩全身麻醉， 术中吸入七氟醚维持麻醉；G组患儿采用气管插管麻醉， 术中持续泵注丙泊酚、瑞芬太尼维持麻醉。两组机械通气采用压力控制通气（PCV）模式， 观察两组患儿插入喉罩或气管导管前（T1）、插入喉罩或气管导管后1 min（T2）、拔出喉罩或气管导管后1 min（T3）时的血压（BP）、心率（HR）、脉搏氧饱和度（SpO2）， 并对比两组的手术时间、术毕至拔管时间、麻醉复苏室（PACU）停留时间。结果 与T1时比较， T2时G组HR、BP均显著增加， 差异均有统计学意义（P<0.05）；G组T2时HR和BP均高于U组， 差异均有统计学意义（P<0.05）。两组手术时间比较差异无统计学意义（P>0.05）；U组术毕至拔管时间（5.1±2.3）min、PACU停留时间（16.2±1.1）min均短于G组的（15.7±2.1）、（25.4±3.5）min， 差異均有统计学意义（P<0.01）。结论 超快通道麻醉是一种安全、有效的可以用于小儿腹腔镜疝气手术的麻醉方法， 能够缩短复苏时间， 减少住院时间， 值得在临床广泛推广应用。

【关键词】 超快通道麻醉；小儿疝气；腹腔镜手术

DOI：10.14163/j.cnki.11-5547/r.2017.17.019

Application of ultra-fast track anesthesia in pediatric laparoscopic hernia operation GUO Xin， HOU Zhi-qi. Guangdong Huizhou City Central Peoples Hospital， Huizhou 516001， China

【Abstract】 Objective To observe the safety and efficacy of ultra-fast track anesthesia applied in pediatric laparoscopic hernia operation. Methods A total of 60 children with laparoscopic hernia operation as study subjects were randomly divided into ultra-fast track anesthesia group （group U） and general anesthesia group （group G）， with 30 cases in each group. Group U received general anesthesia by laryngeal mask and sevoflurane inhalation during operation for anesthesia maintenance， and group G received tracheal intubation anaesthesia and propofol and fentanyl by pump casting during operation for anesthesia maintenance. Both groups received mechanical ventilation in pressure controlled ventilation （PCV） mode. Observation were made on blood pressure （BP）， heart rate （HR）， oxygen saturation （SpO2） before inserting laryngeal mask or endotracheal tube （T1）， 1 min after inserting laryngeal mask or endotracheal tube （T2）， 1 min after extubation of laryngeal mask or endotracheal tube （T3）， and comparison were made on operation time， postoperative extubation time， and post anesthesia care unit （PACU） duration time in two groups. Results Compared with T1， group G had significantly increased HR and BP at T2， and the difference had statistical significance （P<0.05）. Group G had higher HR and BP at T2 than group U， and the difference had statistical significance （P<0.05）. Both groups had no statistically significant difference in operation time （P>0.05）. Group U had shorter postoperative extubation time as （5.1±2.3） min and PACU duration time as （16.2±1.1） min than （15.7±2.1） and （25.4±3.5） min in group G， and their difference had statistical significance （P<0.01）. Conclusion Ultra-fast track anesthesia is a safe effective anesthesia and it can be applied in pediatric laparoscopic hernia operation. It also can shorten recovery time and reduce hospital stay time， so it is worthy of wide application in clinic.

【Key words】 Ultra-fast track anesthesia； Pediatric hernia； Laparoscopic operation

近年来小儿疝气发病率高居不下， 与传统开腹手术相比， 小儿腹腔镜下行疝囊高位结扎手术具有微创、恢复快、无瘢痕、可同时治疗双侧等优点[1]。基于生理方面的特点， 小儿腹腔镜手术的麻醉方式及药物的选择十分重要。为便于呼吸道管理， 保证良好的通气和氧合， 避免出现高CO2血症， 大部分小儿腹腔镜疝气手术都选择气管插管全身麻醉。由于小儿解剖和生理的原因， 气管插管引起的气道损伤， 术后肺部并发症逐渐增多。喉罩的应用可以避免气管插管引起的气道损伤又能够满足腹腔镜手术麻醉的需求， 术中可以维持较好的通气， 术后可以尽快拔除喉罩， 符合现代麻醉提倡的快通道麻醉技术原则。……