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目的:研究腰硬联合麻醉在小儿隐匿性阴茎手术中的临床效果。方法:选择美国麻醉医师协会(ASA)分级Ⅰ或Ⅱ级行隐匿性阴茎整形术的患儿(5岁~8岁)60例,按随机数字表法分为2组(每组30例);A组:利多卡因骶管阻滞;B组:布比卡因腰麻联合硬膜外阻滞组。A组给予行骶管阻滞1%利多卡因6~8mg/Kg;B组行腰麻——硬膜外联合麻醉,腰麻给予0.25%布比卡因2ml(5mg),硬膜外置管;若患儿术中出现明显的体动反应或者呻吟,则静脉给予丙泊酚1~5mg/kg,麻醉前静脉均给予咪达唑仑0.05~0.1 mg/kg,阿托品0.01 mg/kg。严密监测基础和切皮时刻的氧饱和度(oxygen saturation,SPO_2~0和SPO_2~1)、心率(heart rate,HR_0HR_1)以及麻醉起效时间T_1(绝对平面>T12)、作用时间T_2(绝对平面0.05),两组患儿切皮时的SPO_2~1和HR_1与基础值比较均无明显变化(P>0.05);但是两组T_1、T_2和prop比较均有明显差异(P<0.05)。两组患儿术后均无发生头疼和尿潴留,术中A组发生呕吐4例,呻吟体动7例;而B组,呕吐5,呻吟体动2例。结论:腰硬联合麻醉在小儿隐匿性阴茎手术中具有麻醉起效快、效果确切、作用时间较长、呼吸循环影响小、副作用少、局麻药及静脉麻醉药物使用量少等优点,是一种效果好可行的麻醉方法。
Objective: To study the clinical effect of combined spinal and epidural anesthesia in occult penile surgery in children. Methods: Sixty children (aged 5 to 8 years old) with concealed penile plastic surgery under ASA grade I or II were randomly divided into 2 groups (30 in each group) according to random number table. Group A: Lidocaine caudal block; Group B: Bupivacaine combined with spinal epidural block. Group A was given caudal block 1% lidocaine 6 ~ 8mg / Kg; Group B, spinal anesthesia - epidural anesthesia, spinal anesthesia with 0.25% bupivacaine 2ml (5mg), epidural Tube; if there was significant physical reaction or moaning in the operation of the child, propofol was intravenously administered in an amount of 1 to 5 mg / kg, and midazolam 0.05 to 0.1 mg / kg and atropine 0.01 mg / kg were administered intravenously before anesthesia. The oxygen saturation (SPO_2 ~ 0 and SPO_2 ~ 1), heart rate (HR_0HR_1), and the onset of anesthesia T_1 (absolute plane> T12), the action time T_2 (absolute plane 0.05). There was no significant difference in SPO_2 ~ 1 and HR_1 between the two groups (P> 0.05). However, there were significant differences in T_1, T_2 and prop between the two groups (P <0.05). There was no headache and urinary retention in both groups. There were 4 cases of vomiting in Group A and 7 cases of moan in body motion in Group A, and 2 cases of vomiting in Group B and moaning in body motion. Conclusion: Combined spinal and epidural anesthesia has the advantages of rapid onset of anesthesia, definite effect, longer duration of action, less effect of respiratory cycle, less side effects and less use of local anesthetic and venous anesthesia in occult penile surgery in children. Effect of a viable method of anesthesia.