喉罩全麻复合骶麻在小儿麻醉中的应用

Application of laryngeal mask airway anaesthesia combined with sacral canal block in pediatric anaesthesia

摘要:

目的：观察应用喉罩全麻复合骶麻与单纯气管内全麻在小儿外科手术中的利弊，为临床小儿麻醉提供参考。方法：2～12岁行腹部及以下部位择期手术的患儿60例，随机分为喉罩全麻复合骶麻组(喉罩组)和单纯气管内全麻组(气管组)，每组30例。观察患儿麻醉前、置入喉罩（气管）前后及术后拔除时的平均动脉压（MAP）、心率（HR）和SpO2及麻醉苏醒时间、术后疼痛与躁动情况。结果：MAP、HR和SpO2在两组间麻醉前和置入前比较差异无统计学意义(P>0.05)；置入喉罩（气管）后及术后拔除时喉罩组MAP、HR的数值明显低于气管组（P<0.05），喉罩组术后疼痛评分（VAS）值明显低于气管组（P<0.05），麻醉苏醒时间明显短于气管组（P<0.05），术后躁动发生率明显低于气管组（P<0.05）。结论：喉罩全麻复合骶管阻滞麻醉在诱导和苏醒期患儿血液动力学比较平稳，术后疼痛明显降低，苏醒时间较短，且可明显降低术后躁动的发生率。

Abstract:

OBJECTIVE: To compare the advantages and disadvantages between laryngeal mask airway anaesthesia combined with sacral canal block and single tracheal tube anaesthesia in pediatric surgery. METHODS: Sixty 2-12-year-old children for lower limb or lower abdominal surgery were randomly assigned into two groups: a group that was given laryngeal mask airway anaesthesia combined with sacral canal block and a group was given single tracheal tube anaesthesia (n=30 each). Mean arterial pressure (MAP), SpO2 and heart rate (HR) were recorded before induction of anaesthesia, before and after insertion of laryngeal mask airway (LMA) or tracheal tube (TT) and after removal of LMA or TT. The waking-up time, VAS pain scores and the frequency of mania were recorded after surgery. RESULTS: There were no significant differences in MAP, SpO2 and HR between the combined and single anaesthesia groups before anaesthesia and insertion of LMA or TT, while the MAP and HR in the combined anaesthesia group were significantly lower than those in the single anaesthesia group after insertion and removal of LMA or TT (P<0.05). The VAS pain scores were significantly lower and the waking-up time was significantly shorter in the combined anaesthesia group than those in the single anaesthesia group (P<0.05) after surgery. The frequency of mania after surgery in the combined anaesthesia group was significantly lower than that in the single anaesthesia group (P<0.05). CONCLUSIONS: The hemodynamics is more stable in children during the induction and the waking-time of laryngeal mask anesthesia combined with sacral canal block. The anesthesia may relieve postoperative pain, shorten the waking-up time and decrease the frequency of mania.