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目的探讨丙泊酚、γ-羟丁酸钠联合气管表面麻醉应用于小儿气管异物取出术的效果,并与氯胺酮复合咪达唑仑、γ-羟丁酸钠麻醉效果作比较。方法确诊为气道、支气管异物的患儿90例,随机平均分为三组。A组为咪达唑仑、氯胺酮组;B组为γ-羟丁酸钠、氯胺酮组;C组为γ-羟丁酸钠、丙泊酚组。三组均为全身静脉麻醉,观察患儿入室时、置入气管镜前、置入气管镜后HR、MAP、RR及SpO2。观察置入退出气管镜时、术中及术后屏气、挣扎、呛咳、呕吐、术后喉头水肿、舌后坠等情况。结果患儿置入气管镜前及置入气管镜后C组MAP、HR数值显著低于A、B组(P<0.05)。C组置入气管镜前后MAP、HR均显著下降,而A、B组HR变化不明显,MAP均显著上升(P<0.05)。A、B组置入气管镜后RR较入室时显著下降且明显低于C组(P<0.05)。A、B组置入气管镜时,术中及苏醒期屏气、呛咳、术后舌后坠、喉头水肿例数明显多于C组(P<0.05)。苏醒时间较C组明显延长(P<0.05)。结论γ-羟基丁酸钠联合丙泊酚气管表面麻醉效果优于咪达唑仑、氯胺酮组和γ-羟丁酸钠、氯胺酮组,是小儿气管异物取除术的一种较为安全可靠的麻醉方法。
Objective To investigate the effect of propofol and sodium gamma-hydroxybutyrate combined with tracheal topical anesthesia on tracheal foreign body removal in children and compare with the anesthetic effects of ketamine combined with midazolam and sodium gamma-hydroxybutyrate. Methods 90 cases diagnosed as airway and bronchial foreign bodies were randomly divided into three groups randomly. Group A was midazolam and ketamine; group B was sodium gamma-hydroxybutyrate and ketamine; Group C was sodium gamma-hydroxybutyrate and propofol. All three groups were treated by systemic intravenous anesthesia. When the children entered the room, they were placed in front of the bronchoscope, and HR, MAP, RR and SpO2 were placed in the tracheoscope. Observed into the exit bronchoscope, intraoperative and postoperative breath, struggling, cough, vomiting, postoperative laryngeal edema, tongue fall and so on. Results The values of MAP and HR in group C were significantly lower than those in group A and B before and after bronchoscopy (P <0.05). MAP and HR decreased significantly in group C before and after bronchoscopy, while HR in group A and group B did not change significantly (P <0.05). After group A and group B were placed in the bronchoscope RR decreased significantly compared with that in group C (P <0.05). A, B group placed bronchoscope, intraoperative and awake breath, choking, postoperative lingual fall, laryngeal edema cases were significantly more than the C group (P <0.05). Recovery time significantly longer than the C group (P <0.05). Conclusions Sodium gamma-hydroxybutyrate combined with propofol tracheal surface anesthesia is superior to midazolam, ketamine group and sodium gamma-hydroxybutyrate and ketamine group, which is a safe and reliable anesthesia for pediatric tracheal foreign body removal method.