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目的 :对比研究插管全麻与臂丛阻滞联合非插管全麻 ,对小儿拇手指再造手术的麻醉与管理效果的影响。方法 :2 8例 2～ 6岁择期手术患儿 ,随机分为插管全麻组 (G组 ,n =14 )和臂丛阻滞联合非插管全麻组 (BG组 ,n =14 )。G组麻醉诱导依次静注γ -羟基丁酸钠 30～ 6 0mg/kg ,地西泮 0 .1～ 0 .2mg/kg ,1%利多卡因喷喉后 ,经口腔明视插管 ,用T型管法辅助呼吸 ;BG组用 0 .2 5 %布比卡因 1～ 2mg/kg ,施行腋路臂丛阻滞。两组均用0 .1氯胺酮和 0 .0 0 1%芬太尼静脉维持麻醉 ,术中持续给氧。结果 :全麻静脉用药总量BG组非常显著少于G组 (P <0 .0 1) ,清醒时间BG组显著短于G组 (P <0 .0 5 ) ,血液动力学指标术毕后BG组非常显著高于G组 (P<0 .0 1) ,SPO2 术毕后BG组非常显著高于G组 (P <0 .0 1) ,术中吸痰次数 ,术后恶心、呕吐发生率BG组非常显著少于G组 (P <0 .0 1) ,术毕后及回病房后喉、支气管痉挛发生率G组分别为 4 2 .7%和 2 1.4 % ,BG组为零。结论 :两种方法均适用于小儿拇手指再造手术的麻醉 ,但术中麻醉管理臂丛阻滞联合非气管内插管全麻法优于单用气管内插管全麻法。
Objective: To compare the effects of general anesthesia with brachial plexus block and non-intubation general anesthesia on the anesthesia and management of pediatric thumb and thumb reconstruction. Methods: Twenty-eight children undergoing elective surgery from 2 to 6 years old were randomly divided into intubated general anesthesia group (G group, n = 14) and brachial plexus block combined with non-intubated general anesthesia group (BG group, n = 14) . G group anesthesia induction followed by intravenous γ - hydroxybutyrate 30 ~ 60mg / kg, diazepam 0 .1 ~ 0.2mg / kg, 1% lidocaine throat after oral intubation intubation with T-tube assisted breathing; BG group with 0.52% bupivacaine 1 ~ 2mg / kg, axillary brachial plexus block. Both groups were anesthetized with 0.1-ketamine and 0.0101-fentanyl intravenously, with continuous intraoperative oxygenation. Results: The total amount of intravenous anesthesia in BG group was significantly less than that in G group (P <0.01), that in BG group at awake time was significantly shorter than that in G group (P <0.05), and hemodynamic indices BG group was significantly higher than that of G group (P <0.01). BG group was significantly higher than that of G group after SPO2 operation (P <0.01), number of sputum aspiration, postoperative nausea and vomiting The rate of bronchospasm in the BG group was significantly less than that in the G group (P <0.01). After operation and in the back ward, the incidence of bronchospasm was 42.7% and 21.4% respectively in the BG group and zero in the BG group. Conclusion: Both of the two methods are suitable for the anesthesia of pediatric thumb thumb reconstruction surgery. However, anesthesia management with brachial plexus block combined with non-tracheal intubation and general anesthesia is better than single endotracheal intubation and general anesthesia.