【摘要】 目的 比較喉罩全麻與氣管插管全麻兩種麻醉方法在小兒側臥位短小手術中的優缺點。 方法 2009年6月-2010年2月，將40例擇期行側臥位短小手術兒患，隨機分為喉罩全麻（L）組與氣管插管全麻（T）組，每組各20例。觀察患兒術中心率（HR）、平均動脈壓（MAP）、脈搏血氧飽和度（SpO2）、氣道峰壓（Pmax），惡心嘔吐、術后躁動等圍術期不良反應。 結果 T組插管后及拔管后即刻HR、MAP均高于L組患兒（Plt;0.05）；SpO2、Pmax在兩組之間比較差異無統計學意義（Pgt;0.05），T組患兒術后躁動發生率明顯高于L組（Plt;0.05）。 結論 喉罩可以安全、有效地用于小兒側臥位短小手術麻醉，且操作簡便，插管期和拔管期心血管應激反應輕，術后躁動發生率低。【Abstract】 Objective To compare the safety and efficacy of laryngeal mask airway (LMA) and tracheal tube in lateral general anesthetic operation on children. Methods From June 2009 to February 2010, 40 children scheduled to undergo general anesthesia for minor surgical procedures in lateral position were randomly divided into the laryngeal mask airway group (group L) and the tracheal tube group (group T) with 20 in each. Heart rate (HR), mean arterial pressure (MAP), pulse oxygen saturation (SpO2), top airway pressure (Pmax) of the patients were observed. In addition, side effects such as nausea, vomiting, and emergence agitation were also recorded. Results HR and MAP of patients in group T were significantly higher than those of patients in group L after intubation and after extubation (Plt;0.05). There was no difference in Pmax and SpO2 between the two groups (Pgt;0.05). The incidence of emergence agitation in group T was significantly higher than that in group L. Conclusions LMA intubation can provide the same safe and effective ventilation as tracheal intubation for children undergoing lateral general anesthetic operation. LMA is superior to tracheal intubation in insertion response, and the incidence of emergence agitation is lower.
【摘要】 目的 觀察帕瑞昔布鈉超前鎮痛在小兒上肢骨折手術的鎮痛效果及不良反應發生情況。 方法 選擇2009年6月－2010年12月氣管插管全身麻醉下擇期行單側上肢骨折切開復位內固定手術患兒90例，隨機分為帕瑞昔布鈉組（P組）、曲馬多組（T組）及對照組（C組），每組各30例患兒；于麻醉前分別靜脈注射帕瑞昔布鈉1 mg/kg、曲馬多2 mg/kg、等容量生理鹽水。3組患兒年齡、性別、體重、手術時間等一般情況差異無統計學意義（Pgt;0.05）。各組均于術后2、4、6、8 h各時間點觀察患兒疼痛評分、鎮靜評分；觀察拔除患兒氣管導管后5 min躁動評分；記錄患兒術中芬太尼總用量及術后鎮痛藥物用量；隨訪術后24 h內不良反應的發生情況。 結果 術后各個時間點P組疼痛評分明顯低于T、C組（Plt;0.01）；T組鎮靜評分于術后2、4、6 h明顯高于P、C組（Plt;0.01），鎮靜評分在P、C組之間比較差異無統計學意義（Pgt;0.05）；P組術后躁動評分明顯低于T、C組（Plt;0.01）；P組患兒圍手術期芬太尼用量明顯少于T、C組（Plt;0.01）；T組術后惡心嘔吐發生率明顯高于P、C組（Plt;0.05）。P組無呼吸抑制、傷口異常出血等嚴重不良反應。 結論 帕瑞昔布鈉超前鎮痛用于小兒上肢骨折手術可產生明顯鎮痛作用，并可有效預防蘇醒期躁動發生，明顯減少圍手術期芬太尼用量，惡心嘔吐等不良反應發生率明顯低于曲馬多。【Abstract】 Objective To study the efficacy and safety of preemptive analgesia with parecoxib sodium in children undergoing upper limb orthopedic surgery. Methods Ninety children from June 2009 to December 2010 scheduled for elective upper limb orthopedic surgery under general anesthesia were selected and randomly divided into three groups with 30 children in each. For the children in group P (parecoxib sodium), group T (tramadol) and group C (control), preemptive analgesia was induced by an intravenous injection of parecoxib sodium at 1 mg/kg, tramadol at 2 mg/kg, and normal saline respectively before anesthesia. Pain intensity score and sedation score were recorded 2, 4, 6, and 8 hours respectively after operation. The agitation score was measured 5 minutes after extubation. The perioperative fentanyl consumption and postoperative analgesic medicine consumption were recorded. The adverse effects were observed within 24 hours after operation. Results The demographic data such as age, gender, weight, and operation time did not differ statistically among the three groups of children (Pgt;0.05). Compared with groups T and C, the pain score in group P was significantly lower at all time points after operation (Plt;0.01). The sedation score in group T was significantly higher than those in group P and C 2, 4, and 6 hours after operation (Plt;0.01), but the sedation score did not differ significantly between groups P and C (Pgt;0.05). The agitation score after trachea extubation in group P was significantly lower than the other two groups (Plt;0.01). The quantity of fentanyl used in group P was significantly lower than in groups T and C (Plt;0.01). The incidence of postoperative nausea or vomiting in group T was higher than those in groups P and C (Plt;0.05). There was no depression of breath or abnormal hemorrhage in group P. Conclusion Parecoxib sodium has a better analgesic effect in children undergoing upper limb orthopedic surgery. The agitation score and the incidence of postoperative nausea or vomiting are significantly lower, and the use of parecoxib sodium can also significantly reduce the perioperative fentanyl consumption.
目的 評價喉罩聯合T型密封接頭通氣在新生兒無痛纖維支氣管鏡（纖支鏡）診治中的臨床效果。 方法 對2010年3月－2012年10月收治的33例擬行纖支鏡診治的新生患兒，分為喉罩組（Ⅰ組）和常規組（Ⅱ組），兩組患兒在術前半小時均靜脈注射咪唑安定0.2～0.3 mg/kg基礎上，Ⅰ組靜脈注射枸櫞酸芬太尼3～5 μg/kg，置入喉罩聯合T型密封接頭通氣下行纖支鏡診治；Ⅱ組常規表面麻醉下行纖支鏡診治。分析術前（T1）、通過聲門（T2）、診治中（T3）、檢查后（T4），脈搏血氧飽和度（SpO2）、心率（HR）的變化情況、纖支鏡從T型密封接頭入口或鼻孔到通過聲門的時間、鏡檢時間、支氣管肺泡灌洗次數、鏡檢期間不良反應（嗆咳、憋氣、肢體運動、呼吸道損傷）及麻醉滿意度（由內鏡醫師評價）。 結果 Ⅰ組與Ⅱ組比較，T1、T4時間點SpO2、HR差異無統計學意義，T2、T3時間點SpO2＜85%、HR＜100次/min的發生率Ⅰ組與Ⅱ組比較差異有統計學意義（P＜0.01）；纖支鏡從T型密封接頭入口或鼻孔到通過聲門時間差異無統計學意義（P＞0.05）；Ⅱ組鏡檢時間短于Ⅰ組，支氣管肺泡灌洗次數少于Ⅰ組；Ⅰ組不良反應低于Ⅱ組，麻醉滿意度高于Ⅱ組（P＜0.05）。 結論 喉罩聯合T型密封接頭通氣在新生兒無痛纖支鏡診治氣道管理安全有效可行，醫師能從容操作。