七氟烷全凭吸入麻醉用于小儿腭裂手术的临床观察

目的：观察七氟烷复合氧化亚氮全凭吸入麻醉用于小儿腭裂手术的临床效果。方法：选40例按美国麻醉医师学会（American Society of Anesthesiologiests,ASA）身体分级为I～II级的腭裂手术患儿,年龄1.5～4岁,随机分为两组。K组：给予氯胺酮5～8mg/kg＋丙泊酚1.5mg/kg＋维库溴铵0.1～0.15mg/kg诱导插管,术中丙泊酚5～10mg/（kg·h）麻醉维持。S组：给予七氟烷8%面罩吸入＋维库溴铵0.1～0.15mg/kg缓慢静注诱导,术中吸入七氟烷及氧化亚氮和氧气,氧化亚氮1L/min、氧气1L/min,七氟烷1.2～1.5MAC（3%～4%）维持麻醉。根据术中血流动力学状况和手术刺激程度,适当调控麻醉深度。采用SPSS11.0软件包进行统计。结果：两组诱导插管均顺利。K组诱导后患儿心率显著增快（P〈0.01）、血压下降（P〈0.05）,插管及术中剥离腭瓣时仍保持较快心率（P〈0.01）,与S组比较有显著差异（P〈0.01）。S组在诱导后患儿心率、血压有所下降（P〈0.05）,但插管和术中心率血压基本保持平稳。术后S组患儿自主睁眼和拔管的时间显著早于K组（P〈0.05）。结论：七氟烷复合氧化亚氮麻醉能较舒适、平稳地满足小儿腭裂手术要求。

Clinical observation of sevoflurane/nitrous oxide inhalation used for anesthesia in children with cleft palate repair

Objective To evaluate the clinical benefit of sevoflurane combined nitrous oxide anesthesia for pediatric cleft palate repair. Methods Forty American Society of Anesthesiologiests （ASA） physical statusⅠorII children aged 1～4 years undergoing elective cleft palate repair were randomly divided into two groups,20 in each group.Group K： ketamine ＋propofol ＋vecuronium group;Group S：sevoflurane ＋ vecuronium group.Before intubation,children in group K received ketamine （5～8mg/kg）by intramuscular injection and propofol （1.5mg/kg） and vecuronium （0.1～0.15mg/kg） by intravenous infusion,and then received propofol 5 ～10mg/（kg·h） during the maintenance of operation.In group S, anesthesia was induced by inhalation of sevoflurane and vecuronium （0.1～0.15mg/kg）intravenously,was maintained with nitrous oxide 1L/min,oxygen 1L/min and sevoflurane at 1.2～1.5 minimumalveolar concentration （MAC）.We adjusted the depth of anesthesia according to the change of hemodynamics.SPSS11.0 software package was used for comparison of the differences between the groups. Results All children finished the process of induction and intubation successfully . HR increased （P〈0.01）and MAP decreased （P〈0.05）significantly after induction in group K,and HR kept in faster range compared with that in group S（P〈0.01）during the intubation and separation of palatal flap.In group S,HR and MAP had a significant decrease after intubation （P 0.01）,but hemodynamics was stable throughout the operation.During the operation,SpO2 of both groups consistently maintained in normal range.In group S the time to awake and extubate was earlier than that in group K （P〈0.05）. Conclusion Sevoflurane and nitrous oxide can offer superior stable comfortable operation in children.