延缓排除笑气对小儿七氟醚全凭吸入麻醉术后苏醒期的影响
Effect of delayed nitrous oxide wash out on recovery period  after sevoflurane anesthesia in children
投稿时间:2017-10-30  
DOI:10.11724/jdmu.2018.01.11
中文关键词:  七氟醚  笑气  小儿麻醉  苏醒期躁动  眼科短小手术
英文关键词:sevoflurane  nitrous oxide  pediatric anesthesia  emergence agitation  minor ophthalmic surgery
基金项目:基金项目:辽宁省自然基金面上项目(201421087)
作者单位
王 杰 中国医科大学附属盛京医院 麻醉科辽宁 沈阳 110000 
陈宏志 中国医科大学附属盛京医院 麻醉科辽宁 沈阳 110000 
谢亚英 中国医科大学附属盛京医院 麻醉科辽宁 沈阳 110000 
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中文摘要:
      目的 探究延缓排除笑气对小儿眼科短小手术术后苏醒期的影响。方法 选取择期全麻下行眼科短小手术、ASA I~II级、1~3岁患儿60例,随机分成两组:即刻排除笑气组(I组)和延缓排除笑气组(D组),每组30例。手术完成即刻,新鲜气体流量改成6 L/min。I组即刻停止吸入七氟醚和笑气,改为吸入33%的氧气与空气的混合气体(FiO2 =0.33);D组即刻停止吸入七氟醚,继续吸入笑气,待MAC值降至0.6时,改为吸入33%的氧气与空气的混合气体(FiO2 =0.33)。待患儿达到拔管条件,拔出气管导管送入PACU。记录两组患儿拔管时呼气末七氟醚浓度(ETSevo)、呼气末笑气浓度(ETN2O)、BIS值和MAC值。对两组患儿在入PACU即刻及之后每间隔5 min至30 min时的术后躁动情况进行PAED躁动评分、Ramsay镇静评分,记录围术期不良事件。结果 D组患儿在拔管时ETSevo浓度低于I组(P<0.05);D组患儿在拔管时ETN2O浓度高于I组(P<0.05);D组患儿在入PACU即刻、入PACU后5 min及10 min的PAED躁动评分低于I组,差异有统计学意义(P<0.05)。结论 择期行眼科短小手术的患儿,在苏醒期延缓笑气的排除,可以改善小儿术后苏醒期质量。
英文摘要:
      ObjectiveTo investigate the effect of delayed nitrous oxide wash out on recovery period after anesthesia for minor ophthalmology surgery in children.Methods The study enrolled 60 children, who were 1-3 years old, classified as ASA physical status I-II, and scheduled for minor ophthalmic surgery. The patients were randomly allocated to either the immediate wash out nitrous oxide group (group I=30 cases) or the delayed wash out nitrous oxide group (group D=30 cases). At the end of the surgery, the fresh gas flow was adjusted to 6 L/min. In the group I, sevoflurane was discontinued and the inspired N2O was replaced with air (FiO2 =0.33) . In the group D, sevoflurane was discontinued but N2O was continued until the MAC value decreased to 0.6, when the inspired N2O was replaced with air (FiO2 =0.33). The endotracheal tube was extubated until the children meet the indication of extubation. At that time, the end-tidal sevoflurane and nitrous oxide concentrations and the value of BIS and MAC were measured. After arriving at PACU, the PAED score and the Ramsay score were recorded every 5 minutes. The perioperative adverse reactions were observed.ResultsThe end-tidal concentration of sevoflurane at extubation was significantly lower in the group D than that in the group I (P<0.05). The end-tidal concentration of nitrous oxide at extubation was higher in the group D than that in the group I (P<0.05). The PAED scores were significantly lower in the group D arriving at PACU and after 5min、10min (P<0.05).ConclusionDelayed nitrous oxide wash out in recovery period can improve the quality of postoperative recovery in children.
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