异丙酚靶控输注联合气管表面麻醉在婴幼儿气管支气管异物取出术中的应用.doc

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1、异丙酚靶控输注联合气管表面麻醉在婴幼儿气管支气管异物取出术中的应用【摘要】目的:探讨异丙酚靶控输注联合咽喉、气管内表面麻醉应用于小儿气管支气管异物取出术的疗效，并与氯胺酮复合γ-羟基丁酸钠麻醉效果比较。方法:40例婴幼儿气管、支气管异物患儿，年龄8～36个月，体重7.5～18kg，随机分为A组和B组。A组为异丙酚效应室靶控输注联合1%丁卡因咽喉、气管表面麻醉，B组为氯胺酮复合γ-羟基丁酸钠麻醉，观察麻醉效果、并发症和苏醒时间。结果:两组患儿均麻醉成功，全部一次顺利插入硬式支气管镜。B组患儿术中最低SpO2低于A组；支气管镜置入后发生较严重屏气、呛咳需处理的病例A组为1例，B组为5例

2、。B组术毕全部病例发生下颌松弛和舌后坠，显著多于A组（1例）（P<0.01）。术毕发生喉鸣、托下颌仍吸气困难B组12例，显著多于A组（0例）。B组患儿术毕在手术室滞留时间、苏醒时间长于A组（P<0.01）。结论:异丙酚靶控输注联合气管表面麻醉是一种可控性强、安全、实用的婴幼儿气管支气管异物取出术的麻醉方法。【关键词】异丙酚药物释放系统表面麻醉婴幼儿气管异物Abstract:Objective:Toinvestigatetheeffectofpropofoltargetcontrolledinfusion(TCI)com-binedthroatandtracheatopi

3、calanaesthesiafortheremovaloftracheobronchialforeignbodyinchildrenandcompareittoketaminecombinedsodiumγ-hydroxybutrateanaesthesia.Methods:Fortypatients,aged8～36months,weighted7.5～18kgandscheduledtobeundergoneremovaloftracheobronchialforeignbodywererandomlyenrolledintotwogroups:groupAandgroupB.

4、PropofolTCIcombinedthroatandtracheatopicalanaesthesiawith1%decicainewasusedingroupA.Ketaminecombinedsodiumγ-hydroxybutrateanaesthesiawasappliedingroupB.Effectofanaesthesia,complicationandpalinesthesiatimewereobserved.Results:Anaesthesiawassuccessfulandrigidbronchoscopewasinsertedsmoothlyatonet

5、imeinallpatients.TheminimumSpO2ingroupBwaslowerthanthatingroupA（P<0.01）;Theseverebreathholdingandbuckingafterinsertingbronchoscopewere1caseingroupAand5ingroupB.OccurrenceofmandibularrelaxandglossocomawasobservedinallpatientsingroupB,whileitwasonly1ingroupA.ItwassignificantlymoreingroupBthan

6、thatingroupA（P<0.01）.Laryngealstridoranddyspneaininspirationwhenholdingmandibularwereobservedin12patientsingroupBandnoneoccurredingroupA.ItwasnotablelymoreingroupBthanthatingroupA（P<0.01）.ComparingwithgroupA.stayedtimeaftersurgeryinoperatingroomandpalinesthesiatimeweresignificantlylonger

7、ingroupB（P<0.01）.Conclusion:PropofolTCIcombinedtracheatopical5anaesthesiaissafe,practicalandcanbecontrolledforremovaloftracheobronchialforeignbodyinchildren.Keywords:propofol;drugdeliverysystems;topicalanaesthesia;infant;trachea;fore