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目的儿童阻塞性睡眠呼吸暂停低通气综合征(OSAHS)的气道管理较为复杂,本研究拟寻找一种安全、有效的麻醉诱导方式。方法随机选择OSAHS患儿160例分两组,手术方式为双侧扁桃体切除加腺样体吸割。静脉麻醉诱导后当BIS监测达50%时,A组,声门外1%地卡因喷雾,充分弥漫后静注维库溴胺0.1mg/kg;B组,静注维库溴胺0.1mg/kg。气管插管评分后,麻醉医师插入喉镜,完成气管插管。另外分别在基础值(T1),插管后2min(T2),插管后5 min(T3),插管后10min(T4)监测并记录血流动力学参数(BP、MAP、HR)和BIS值,采集静脉血测定血糖。计算心率收缩压乘积(RPP)。记录手术结束到苏醒时间(唤之能醒,睫毛反射)。结果在麻醉诱导期间两组患儿气管插管评分比较差异均无统计学意义。A组较B组明显缩短麻醉诱导到插管时间。麻醉诱导后B组2min HR较基础值有显著增快。麻醉诱导后2min RPP较基础值有显著增高。其余各时段与基础值相比较差异均无统计学意义。两组患儿没有发生心率降低和低血压。结论麻醉诱导辅以局麻浸润插管可以提供令人满意的插管条件,并且血流动力学反应平稳,应激反应小,缩短了麻醉诱导时间,减少了麻醉并发症的发生,值得推广应用。
Objective To study the complicated airway management in obstructive sleep apnea-hypopnea syndrome (OSAHS) in children. This study aimed to find a safe and effective way of anesthesia induction. Methods A total of 160 children with OSAHS were randomly divided into two groups. The surgical methods were bilateral tonsillectomy and adenoid abscess. When BIS monitoring reached 50% after induction of intravenous anesthesia, group A, 1% dexamethasone aerosol spray after intravenous injection of vecuronium 0.1 mg / kg; Group B, intravenous injection of vecuronium 0.1 mg / kg. After intratracheal intubation score, the anesthesiologist inserts the laryngoscope and completes the endotracheal intubation. In addition, hemodynamic parameters (BP, MAP, HR) and BIS were monitored and recorded at baseline (T1), 2min after intubation (T2), 5min after intubation (T3) and 10min after intubation (T4) Value, blood was collected for the determination of blood glucose. Calculate the heart rate systolic pressure product (RPP). Record the end of surgery to wake up time (wake up, eyelash reflex). Results There was no significant difference in tracheal intubation scores between the two groups during induction of anesthesia. A group than the B group significantly shortened anesthesia induced intubation time. After induction of anesthesia B group HR 2min significantly increased compared with the baseline value. RPP was significantly higher than baseline at 2 minutes after induction of anesthesia. The rest of the time and the basic values were no significant difference. No heart rate reduction and hypotension occurred in both groups. Conclusion Induction of anesthesia supplemented with local anesthetic intubation can provide satisfactory conditions for intubation, and hemodynamic response is smooth, the stress response is small, shorten the induction time of anesthesia, reduce the occurrence of anesthesia complications, it is worth to promote the application .