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目的观察改良骶管麻醉复合静吸全麻在儿童先天性髋关节脱位手术中的临床应用效果。方法儿童先天性髋关节脱位患者80例,年龄2.5~7.0岁,ASA均为Ⅰ级,肺功能正常。随机分为N、S两组,每组40例。N组患儿肌内注射氯胺酮5 mg/kg后开放静脉,择骶3~4间隙行改良骶管麻醉后注入0.3%罗哌卡因和曲马多混合液,患儿平卧位后吸入6%七氟醚,置入LMA喉罩,术中保留自主呼吸。手术结束前5 min关闭七氟醚挥发罐,术毕加大氧流量洗出七氟醚,患儿苏醒即刻拔出喉罩。S组诱导采用咪达唑仑、阿曲库铵、丙泊酚、芬太尼,气管插管后机械通气,潮气量8~10 ml/kg,麻醉维持用微量泵持续输注丙泊酚、雷米芬太尼,术毕前5 min停用丙泊酚和雷米芬太尼,待患儿自主呼吸恢复后拔除气管导管。观察两组的不同时点平均动脉压、心率、脉搏血氧饱和度、术毕拔喉罩/气管导管时间、术毕苏醒时间、术后出现疼痛时间。结果术毕苏醒时间、拔喉罩/气管导管时间,N组明显短于S组(P均<0.05),术后出现疼痛时间N组明显长于S组(P<0.05)。术后回访N组并发症明显少于S组(P<0.05)。结论儿童先天性髋关节脱位手术应用改良骶管麻醉复合静吸全麻麻醉,血流动力学稳定,术毕苏醒迅速,镇痛完全,并发症少,安全有效。
Objective To observe the clinical effect of modified caudal anesthesia combined with static anesthesia in children with congenital dislocation of the hip. Methods 80 cases of children with congenital dislocation of the hip, aged 2.5-7.0 years, ASA grade Ⅰ, pulmonary function was normal. Randomly divided into N, S two groups, 40 cases in each group. In group N, intramuscular injection of ketamine 5 mg / kg was used to open the veins. After the sacral anesthesia, the rabbits were infused with 0.3% ropivacaine and tramadol. The patients received supine 6 % Sevoflurane, LMA laryngeal mask, intraoperative retained spontaneous breathing. Sevoflurane tank was closed 5 min before the end of surgery, oxygen flow was washed out sevoflurane surgery, children wake up immediately pull the laryngeal mask. S group induced by midazolam, atracurium, propofol, fentanyl, mechanical ventilation after tracheal intubation, tidal volume 8 ~ 10 ml / kg, anesthesia maintenance with a small pump continuous infusion of propofol, Remifentanil, propofol and remifentanil discontinued 5 min before the operation, until the children with spontaneous breathing recovery after removal of endotracheal tube. The mean arterial pressure, heart rate, pulse oximetry, laryngeal mask / endotracheal tube during operation, time of recovery from operation, time of pain after operation were observed. Results The recovery time of laryngeal mask and endotracheal tube were significantly shorter in group N than those in group S (all P <0.05). The duration of postoperative pain in group N was significantly longer than that in group S (P <0.05). The postoperative N group had fewer complications than S group (P <0.05). Conclusion The operation of congenital dislocation of the hip in children with modified sacral anesthesia combined with static anesthesia anesthesia, hemodynamic stability, rapid recovery after surgery, complete analgesia, fewer complications, safe and effective.