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目的:观察喉罩下丙泊酚复合雷米芬太尼加神经刺激器引导下臂丛阻滞的快通道麻醉在小儿上肢骨折术中的应用效果,并与传统的麻醉方法咪唑安定加氯胺酮作比较。方法:选择ASAⅠ级小儿上肢骨折手术40例。随机分为2组:试验组(喉罩下丙泊酚复合雷米芬太尼加神经刺激器引导下臂丛阻滞)20例和对照组(咪唑安定+氯胺酮)20例。试验组患儿静脉注射丙泊酚和雷米芬太尼后置入喉罩,连接麻醉机控制通气,麻醉维持采用丙泊酚和雷米芬太尼持续输注。1%利多卡因8㎎/㎏在神经刺激器引导下臂丛阻滞,手术结束停麻醉药。对照组静脉给予咪唑安定和氯胺酮,术中微量泵入咪唑安定加氯胺酮,术中根据需要调整输注速度,手术结束前5min停药。记录两组患儿的镇静镇痛效果、术中SPO2、手术时间、苏醒时间。结果:两组患儿术中镇静镇痛效果均能满足手术需要,差异无统计学意义;两组患儿术中SPO2差异有统计学意义,试验组对气道的控制优于对照组;两组患儿手术时间差异无统计学意义,苏醒时间差异有统计学意义,对照组显著长于试验组。结论:喉罩下丙泊酚复合雷米芬太尼加神经刺激器引导下臂丛阻滞是小儿上肢骨折手术一种很好的快通道麻醉技术。
OBJECTIVE: To observe the effect of fast-track anesthesia with brachial plexus block guided by propofol combined with remifentanil and neurostimulator in children with upper extremity fracture under laryngeal mask.METHODS: Compared with traditional anesthetic methods, midazolam plus ketamine Compare Methods: Forty ASA Ⅰ pediatric upper limb fractures were selected. The rats were randomly divided into two groups: 20 in trial group (propofol combined with remifentanil plus neurostimulator under laryngeal mask) and 20 in control group (midazolam + ketamine). In the experimental group, propofol and remifentanil were injected intravenously into the laryngeal mask, then the anesthesia machine was used to control the ventilation. The anesthesia was maintained by continuous infusion of propofol and remifentanil. 1% lidocaine 8 ㎎ / 臂 brachial plexus block under the guidance of neurostimulator, stop anesthesia at the end of surgery. In the control group, midazolam and ketamine were given intravenously. The patients were injected with midazolam and ketamine intraoperatively, and the infusion rate was adjusted according to the need during the operation. The patients were stopped 5 minutes before the end of surgery. The sedation analgesic effect, intraoperative SPO2, operation time and recovery time were recorded. Results: The analgesic effect of sedation in both groups can meet the need of operation, the difference was not statistically significant. The difference of SPO2 between the two groups was statistically significant, the control group had better control of airway than the control group. There was no significant difference between the two groups in the operation time, the difference in recovery time was statistically significant, the control group was significantly longer than the experimental group. Conclusion: Propofol combined with remifentanil and neurostimulator under laryngeal mask is a good technique for fast-track anesthesia in pediatric upper limb fracture surgery.