组合式吸入麻醉诱导装置在小儿入手术室困难中的应用

发布时间：2018-02-27 10:26

本文关键词： 组合式吸入麻醉诱导装置氯胺酮七氟醚小儿人性化　出处：《安徽医科大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的如何让小儿安静下来实施静脉注射,如何减轻患儿进入手术室对陌生环境和医护人员的恐惧,同时也避免哭闹对家长的心理伤害,使小儿麻醉的实施更加安全更加人性化,一直是我们医护人员急于解决的问题。七氟醚广泛应用于小儿麻醉中,但其多是于专门的麻醉准备室或手术室里采用固定的大型麻醉机和专用吸入麻醉药的挥发罐进行麻醉。为此,我们研制一种简易便携的组合式吸入麻醉诱导装置(已获专利,专利号:201520078850.3)用于术前焦虑患儿的麻醉。方法选取105例接受择期短小手术的患儿,其中5例因手术时间过长排除,采用随机数字表法分为A组和B组,各50例。A组通过简易的组合式吸入麻醉诱导装置吸入氧气-七氟醚混合气体,B组在臀部肌肉注射氯胺酮4~5mg/kg,麻醉医生在术前访视时,对A组患儿家长做一个组合式吸入麻醉诱导装置使用相关内容的讲解。患儿入睡后接入手术室进行静脉穿刺等一系列手术准备。观察两组患儿的入睡时间,出PACU时间,静脉穿刺时体动例数,不良反应。结果1.两组患儿性别构成、年龄、体重、病情等比较差异无统计学意义(P0.05)。2.A组与B组比较,入睡时间快,出PACU时间明显缩短,有显著差异(P0.001)。3.B组静脉穿刺时45例发生体动,A组静脉穿刺时10例因提早停止吸入而发生体动,两组有明显差异(P0.001)。4.A组有6例发生躁动,B组有48例,躁动发生率B组明显高于A组,差异有统计学意义(P0.001);分泌物增多A组7例,B组21例,A组出现率低于B组,有显著差异(P0.05);A组低氧血症发生2例,B组低氧血症发生5例,两组未见差异(P0.05);恶心呕吐两组均未发生。结论1.家长陪伴下的麻醉诱导减轻了家长的担心和焦虑,使麻醉更人性化,其方式更易于被患儿和家长接受,值得临床推广使用。2.组合式吸入麻醉诱导装置制作方便,便于携带,将输氧、辅助呼吸和吸入麻醉三者功能结合起来,解决小儿入室困难时,效果明显,不良反应少,临床应用更安全。
[Abstract]:Objective how to make children quiet and carry out intravenous injection, how to reduce the fear of children entering the operating room to strange environment and medical staff, and at the same time to avoid the psychological injury caused by crying to parents, so as to make the implementation of pediatric anesthesia more safe and humanized. Sevoflurane is widely used in pediatric anesthesia. However, most of them are anesthetized in specialized anesthetic preparation rooms or operating rooms using fixed large anesthetic machines and volatile tanks for inhalation anesthetic. For this purpose, we have developed a simple portable combined inhalation anesthetic induction device (patented). The patent number: 201520078850.3) was used to anesthetize children with anxiety before operation. Methods 105 cases of children undergoing elective short surgery were selected. Five of them were divided into group A and group B by random digital table because of the exclusion of the operation time. Group A (n = 50) received intramuscular injection of ketamine 4 mg / kg after inhaling oxygen sevoflurane mixture gas by a simple combination of inhaling anesthetic induction devices. The anesthesiologist visited before operation. The parents of group A were given an explanation of the related contents of a combined inhaled anesthetic induction device. After falling asleep, the children went to the operating room for a series of surgical preparations, such as venipuncture. The time of falling asleep and the time of PACU were observed. Results 1. There was no significant difference in sex composition, age, body weight and illness between the two groups. Compared with group B, group A had faster sleep time and shorter time of PACU. There was a significant difference between two groups (P 0.001) .3.The incidence of restlessness in group B was significantly higher than that in group A. There was a significant difference between two groups in the incidence of restlessness in group B (48 cases), and the incidence of restlessness in group B was significantly higher than that in group A (10 cases) due to the early cessation of aspiration, and there was a significant difference between the two groups in 6 cases of restlessness in group B. The difference was statistically significant (P 0.001), the occurrence rate of secretions increased in group A (n = 7) and group B (n = 21) was lower than that in group B (n = 21), and there was a significant difference between group A (n = 2) and group B (n = 5), there were significant differences between group A (n = 2) and group B (n = 5). There was no difference between the two groups (P 0.05) and nausea and vomiting did not occur in both groups. Conclusion 1. The anesthesia induction with the parents' company alleviates the anxiety and anxiety of the parents, makes the anesthesia more humane, and is more easily accepted by the children and the parents. 2. It is worth popularizing and using in clinic. The combined inhaled anesthesia inducer is easy to make, easy to carry, combines the functions of oxygen infusion, assisted respiration and inhalation anesthesia, and solves the difficulties of infantile entry, the effect is obvious, and the adverse reaction is less. Clinical application is safer.
【学位授予单位】：安徽医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R726.1

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