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目的:总结七氟醚吸入在小儿白内障超声乳化联合人工晶体植入术中的麻醉效果和安全性。方法:收集2009年5月至2010年8月期间在北京同仁医院用七氟醚进行全身麻醉行白内障超声乳化联合人工晶体植入术的145例患儿(男84例,女61例,年龄3～8岁,美国麻醉医师协会分级I～II级)的临床资料并进行回顾性分析。麻醉诱导:经面罩吸入8%七氟醚,氧流量为5 L/min。患儿意识消失后开放静脉,脑电双频指数(BIS)<60且下颌松弛后置入喉罩。麻醉维持:术中经喉罩吸入3%～4%七氟醚,氧流量为2 L/min,保留患儿自主呼吸,间断辅助通气。记录患儿麻醉诱导前(T1)、意识消失后BIS下降至最低值时(T2)、喉罩置入前(T3)和麻醉维持期(T4)的BIS、心率和呼吸频率,监测麻醉诱导和维持期间患儿出现咳嗽、屏气、喉痉挛、呕吐、分泌物增加或低氧血症等不良反应的发生情况。结果:麻醉诱导前患儿的BIS为94～98(98±2),心率为(111±10)次/min;吸入8%七氟醚15～34(20±3)s后意识消失,BIS降至12～38(23±7),心率加快至(160±12)次/min,最快达180次/min,与诱导前相比差异均有统计学意义(均P<0.01)。106例患儿(73.1%)在BIS最低点时出现肢体与躯体急扭,持续5～10 s后扭动消失。BIS上升至24～42(35±4)且患儿下颌松弛时可顺利置入喉罩。置入喉罩前患儿心率下降至(97±10)次/min,与诱导前[(111±10)次/min]相比差异有统计学意义(P<0.01)。麻醉诱导期患儿的呼吸频率为(21.6±3.4)次/min,麻醉维持期为(29.0±3.8)次/min,与诱导前的(24.6±3.6)次/min相比,差异均有统计学意义(均P<0.01)。麻醉诱导和维持过程中所有患儿均未发生屏气、喉痉挛、咳嗽、分泌物增加、呕吐、低氧血症等严重不良反应并顺利完成手术。结论:七氟醚吸入全身麻醉用于小儿白内障手术效果好且安全,但在麻醉诱导时应加强对患儿的监测,以防止因肢体、躯体急扭出现的意外伤害。
Objective: To summarize the anesthetic effect and safety of sevoflurane inhalation in pediatric cataract phacoemulsification and intraocular lens implantation. Methods: A total of 145 children (84 males, 61 females, age 3 years) with phacoemulsification and intraocular lens implantation undergoing general anesthesia with sevoflurane in Beijing Tongren Hospital from May 2009 to August 2010 were collected. ~ 8 years old, American Society of Anesthesiologists grade I ~ II) clinical data and retrospective analysis. Anesthesia induction: inhalation of 8% sevoflurane via mask, oxygen flow of 5 L / min. After the disappearance of consciousness in children with open veins, bispectral index (BIS) <60 and relaxation of the mandible into the laryngeal mask. Anesthesia maintenance: intraoperative laryngeal mask inhalation of 3% to 4% sevoflurane, oxygen flow of 2 L / min, leaving children with spontaneous breathing, intermittent assisted ventilation. BIS, heart rate and respiratory rate were monitored before anesthesia induction (T1), BIS decreased to the lowest (T2), laryngeal mask placement (T3) and anesthesia maintenance period (T4) During the maintenance of children with cough, breath holding, laryngospasm, vomiting, increased secretions or hypoxemia and other adverse reactions. Results: Before the induction of anesthesia, the BIS was 94-98 (98 ± 2) and the heart rate was (111 ± 10) / min. After the inhalation of 8% sevoflurane for 15-34 (20 ± 3) s, the awareness of BIS (P <0.01). The difference was statistically significant (P <0.01) between 12 and 38 (23 ± 7) and heart rate accelerated to (160 ± 12) times / min and fastest 180 times / min. 106 cases of children (73.1%) appeared in the lowest point of BIS limbs and body torsion, continued 5 ~ 10 s twist disappeared. BIS rose to 24 ~ 42 (35 ± 4) and the laryngeal mask was successfully placed when the patient’s mandible was relaxed. The heart rate in children with laryngeal mask dropped to (97 ± 10) beats / min, which was significantly different from that before induction (111 ± 10 beats / min) (P <0.01). The respiratory rate was (21.6 ± 3.4) min / min in anesthesia induction period and (29.0 ± 3.8) min / min in anesthesia induction period, compared with 24.6 ± 3.6 / min before induction, the difference was statistically Significance (both P <0.01). During anesthesia induction and maintenance, no serious breath-hold, laryngospasm, cough, increased secretions, vomiting, hypoxemia and other serious adverse reactions occurred in all children and successfully completed the operation. CONCLUSIONS: Sevoflurane inhalation anesthesia is effective and safe for pediatric cataract surgery. However, monitoring of children should be strengthened during anesthesia induction to prevent accidental injury caused by limbs and torso twisting.