摘要
目的探讨腹腔镜婴幼儿先天性巨结肠根治术不同麻醉方式的临床疗效。方法选取收治的拟行腹腔镜先天性巨结肠根治术的婴幼儿患者60例,按照简单数字表法随机分为观察组和对照组各30例,对照组患者采用插管全麻,观察组患者采用全麻复合骶管阻滞,记录两组患儿T_1(术前)、T_2(CO_2气腹后5min)、T_3(CO_2气腹后10min)、T_4(CO_2气腹放气后5min)、T_5(肛门操作5min后)的心率(HR)、收缩压(SBP)、舒张压(DBP)以及气道峰值(PIP),芬太尼、维库溴铵以及异丙酚的用量,观察两组患儿的术后并发症发生率及术后苏醒时间。结果两组患儿术后HR、SBP、DBP以及PIP指标均明显高于术前(P<0.05);观察组患儿HR、SBP、DBP以及PIP指标均明显优于对照组(P<0.05)。观察组患儿维库溴铵[(88.77±10.24)μg/kg·h]、芬太尼[(2.87±6.23)μg/kg·h]和异丙酚[(5.33±0.70)mg/kg·h]用量均明显少于对照组(P<0.05),且观察组患儿术后苏醒时间[(12.25±5.27)min]显著短于对照组[(17.32±5.22)min,P<0.05],两组患儿术后均出现不同程度的不良反应,其中对照组患儿的不良反应发生率(33.33%)明显高于观察组(20.00%,P<0.05)。结论腹腔镜婴幼儿先天性巨结肠根治术中应用骶管阻滞复合全麻的临床效果显著,能够有效减少麻醉性镇痛药的用量,从而有效减少术后不良反应的发生率,具有较高的安全性,可在临床推广应用。
Objective To explore the clinical effect of different anesthesia on radical operation of infant laparoscopic congenital megacolon. Methods 60 infants with congenital megacolon were randomly divided into into observation group （30 cases） and control group （30 cases）. The control group was treated with tracheal intubation. The observation group was treated with general anesthesia combined with sacral block. The HR, SBP, DBP and PIP were recorded at T1 （before operation）, T2 （5min after CO2 pneumoperitoneum）, T3 （10min after CO2 pneumoperitoneum）, T4 （10min after CO2 pneumoperitoneum ending） and T5 （5min after anal operation）. The dose of fentanyl, propofol and vecuroniun was recorded. The incidence of postoperative complications and postoperative waking time were observed. Results The HR, SBP, DBP and PIP of T2, T3, T4 and T5 were significantly higher than T1 （P〈0.05）, and the HR, SBP, DBP and PIP of ob servation group were significantly better than that of control group （P〈0.05）. The dose of vecuronium of observation group[（88.77±10.24）μg/kg] hi , fentanyl [（2.87±6.23）μg/kg ] hi and propofol [（5.33±0.70） mg/kg] hi were significantly less than that of control group （P〈0.05）. The postoperative revival time of observation group （12.25±5.27） min was significantly shorter than that of the control group[ （17. 32± 5.22）min P〈0.05]. The different degree of adverse reactions of observation group was significantly lower than that of the control group. （P〈 0.05）. Conclusion The clinical effect of infant laparoscopic radical operation of congenital megaeolon is remarkable, which can effectively reduce the dosage of the narcotic analgesics and the incidence of postoperative adverse reactions.
出处
《西部医学》
2017年第3期378-381,共4页
Medical Journal of West China
基金
四川省科技厅科研支撑计划项目(20154866251)
关键词
腹腔镜
婴幼儿
先天性巨结肠根治术
插管全麻
骶管阻滞复合全麻
Laparoscopie
Infants and young children
Congenital megacolon radical
Intubation anesthesia
Compound epidural anesthesia
