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目的探讨8%七氟醚单次呼吸诱导用于小儿全麻的可行性和临床意义。方法择期小儿气管内全麻病例40例,术前各项检查结果均正常,无上呼吸道感染及哮喘病史。随机分为2组:Ⅰ组(七氟醚组20例)和Ⅱ组(丙泊酚组20例)。入室后Ⅰ组采用8%七氟醚单次呼吸诱导(单次肺活量法),加压面罩密闭吸入8%的七氟醚,氧流量为6L/min,待其入睡后吸入浓度改为3%～4%,氧流量为4L/min,随后开放静脉,静脉注射3μg/kg芬太尼;Ⅱ组先开放静脉,静脉注射3μg/kg的芬太尼,1min后静脉注射3mg/kg的丙泊酚。当2组患儿的睫毛反射消失后静脉注射0.15mg/kg顺式阿曲库铵,待肌松后行气管内插管,控制呼吸。观察2组意识消失时间、气管插管时间及有无插管反应(肢动、呛咳、喉痉挛等),以及诱导前、插管时和插管后1、5、10min的SBP、DBP、HR变化。结果Ⅱ组较Ⅰ组意识消失时间、气管插管时间明显缩短(P均<0.05)。2组插管时及插管后各时点的SBP低于诱导前(P均<0.05)。Ⅱ组插管时HR慢于诱导前(P<0.05),Ⅰ组各时点的HR与诱导前相比差异均无统计学意义(P均>0.05)。结论8%七氟醚单次呼吸诱导用于小儿全麻是可行的,易被患儿接受。
Objective To investigate the feasibility and clinical significance of single breath induction with 8% sevoflurane for general anesthesia in children. Methods Elective pediatric endotracheal anesthesia in 40 cases, preoperative examination results were normal, no history of upper respiratory tract infection and asthma. Randomly divided into two groups: Ⅰ group (sevoflurane group 20 cases) and Ⅱ group (20 cases of propofol group). After induction, 8% sevoflurane was inhaled by 8% sevoflurane single breath inhalation (group Ⅰ), oxygen flow rate was 6 L / min, and the inhalation concentration was changed to 3% ~ 4% oxygen flow rate 4L / min, followed by open venous, intravenous injection of 3μg / kg fentanyl; group Ⅱ open venous first intravenous injection of 3μg / kg of fentanyl, 1min after intravenous injection of 3mg / kg of propofol phenol. When the two groups of children disappear after the lashes reflex intravenous injection of 0.15mg / kg cisatracurium, muscle relaxation after endotracheal intubation, control of breathing. The duration of tracheal intubation and the presence or absence of intubation (limb movements, cough, laryngospasm, etc.) were observed before and during intubation, and the SBP, DBP, HR changes. Results Compared with group Ⅰ, the disappearance of consciousness and the time of tracheal intubation were significantly shorter in group Ⅱ (all P <0.05). SBP in both groups at intubation and at various time points after intubation was lower than before induction (P <0.05). The HR of intratracheal intubation of group Ⅱ was slower than that of pre-induction (P <0.05). There was no significant difference in HR between pre-induction and control group at each time point (all P> 0.05). Conclusion 8% sevoflurane single breath induction for pediatric general anesthesia is feasible and easily accepted by children.