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

关键词:  七氟醚  笑气  小儿麻醉  苏醒期躁动  眼科短小手术

Key words:  sevoflurane  nitrous oxide  pediatric anesthesia  emergence agitation  minor ophthalmic surgery

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。

Abstract:

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.