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目的对比观察单纯全麻及骶管阻滞复合全麻对新生儿腹腔镜幽门环肌切开术的麻醉效果。方法 36例新生儿腹腔镜幽门环肌切开术患儿随机分为Ⅰ组(全麻)和Ⅱ组(骶管+全麻),Ⅰ组患儿气管插管后吸入七氟醚维持麻醉,Ⅱ组患儿行骶管阻滞后吸入七氟醚维持麻醉,对比两组患儿气腹前后呼吸循环参数指标变化及气腹压力,拔管时间等。结果两组患儿手术时间,CO2气腹时间无显著性差异(P>0.05),Ⅱ组患儿气腹压力(10.2±1.7)mmHg小于Ⅰ组患儿气腹压力(13.2±2.1)mmHg,有显著性差异(P<0.05)。Ⅱ组患儿拔管时间(4.5±1.1)min短于Ⅰ组(8.5±1.5)min,有显著性差异(P<0.05)。Ⅰ组患儿气腹后10min PIP值(28.3±5.6)cm H2O显著高于Ⅱ组(24.7±4.6)cm H2O(P<0.05),Ⅰ组患儿气腹后20min PIP值(29.5±5.7)cm H2O显著高于Ⅱ组(25.5±4.9)cm H2O(P<0.05)。HR、MAP、PetCO2、SpO2各时点组间比较无显著性差异(P>0.05)。结论骶管阻滞复合全麻及单纯全麻均能为新生儿腹腔镜幽门环肌切开术提供满意,有效,合理的麻醉。
Objective To compare the anesthetic effects of general anesthesia and caudal block combined general anesthesia on neonatal laparoscopic pyloroplasty. Methods Thirty-six neonates with laparoscopic pyloroplasty were randomly divided into group Ⅰ (general anesthesia) and group Ⅱ (caudal + general anesthesia). In group Ⅰ, sevoflurane was inhaled after tracheal intubation to maintain anesthesia, Patients in group Ⅱ received sevoflurane inhalation of sevoflurane to maintain anesthesia. The changes of respiratory parameters before and after pneumoperitoneum, pneumoperitoneum pressure and extubation time were compared between the two groups. Results The pneumoperitoneum pressure (10.2 ± 1.7) mmHg in group Ⅱ was less than that in group Ⅰ (13.2 ± 2.1) mmHg at operation time and CO2 pneumoperitoneum time (P> 0.05) There was significant difference (P <0.05). The extubation time in group Ⅱ was shorter than that in group Ⅰ (4.5 ± 1.1) min (8.5 ± 1.5) min (P <0.05). The PIP (28.3 ± 5.6) cm H2O in group Ⅰ was significantly higher than that in group Ⅱ (24.7 ± 4.6) cm H2O at 10 min after pneumoperitoneum (P <0.05). The PIP in group Ⅰ was 20.5 min after pneumoperitoneum (29.5 ± 5.7) cm H2O was significantly higher than that of group Ⅱ (25.5 ± 4.9) cm H2O (P <0.05). HR, MAP, PetCO2, SpO2 at different time points were no significant difference (P> 0.05). Conclusion Sacral block combined with general anesthesia and general anesthesia can provide satisfactory, effective and reasonable anesthesia for laparoscopic pyloroplasty.