本文關(guān)鍵詞： 組合式吸入麻醉誘導(dǎo)裝置 氯胺酮 七氟醚 小兒 人性化　出處：《安徽醫(yī)科大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：目的如何讓小兒安靜下來實(shí)施靜脈注射,如何減輕患兒進(jìn)入手術(shù)室對(duì)陌生環(huán)境和醫(yī)護(hù)人員的恐懼,同時(shí)也避免哭鬧對(duì)家長(zhǎng)的心理傷害,使小兒麻醉的實(shí)施更加安全更加人性化,一直是我們醫(yī)護(hù)人員急于解決的問題。七氟醚廣泛應(yīng)用于小兒麻醉中,但其多是于專門的麻醉準(zhǔn)備室或手術(shù)室里采用固定的大型麻醉機(jī)和專用吸入麻醉藥的揮發(fā)罐進(jìn)行麻醉。為此,我們研制一種簡(jiǎn)易便攜的組合式吸入麻醉誘導(dǎo)裝置(已獲專利,專利號(hào):201520078850.3)用于術(shù)前焦慮患兒的麻醉。方法選取105例接受擇期短小手術(shù)的患兒,其中5例因手術(shù)時(shí)間過長(zhǎng)排除,采用隨機(jī)數(shù)字表法分為A組和B組,各50例。A組通過簡(jiǎn)易的組合式吸入麻醉誘導(dǎo)裝置吸入氧氣-七氟醚混合氣體,B組在臀部肌肉注射氯胺酮4~5mg/kg,麻醉醫(yī)生在術(shù)前訪視時(shí),對(duì)A組患兒家長(zhǎng)做一個(gè)組合式吸入麻醉誘導(dǎo)裝置使用相關(guān)內(nèi)容的講解�；純喝胨蠼尤胧中g(shù)室進(jìn)行靜脈穿刺等一系列手術(shù)準(zhǔn)備。觀察兩組患兒的入睡時(shí)間,出PACU時(shí)間,靜脈穿刺時(shí)體動(dòng)例數(shù),不良反應(yīng)。結(jié)果1.兩組患兒性別構(gòu)成、年齡、體重、病情等比較差異無統(tǒng)計(jì)學(xué)意義(P0.05)。2.A組與B組比較,入睡時(shí)間快,出PACU時(shí)間明顯縮短,有顯著差異(P0.001)。3.B組靜脈穿刺時(shí)45例發(fā)生體動(dòng),A組靜脈穿刺時(shí)10例因提早停止吸入而發(fā)生體動(dòng),兩組有明顯差異(P0.001)。4.A組有6例發(fā)生躁動(dòng),B組有48例,躁動(dòng)發(fā)生率B組明顯高于A組,差異有統(tǒng)計(jì)學(xué)意義(P0.001);分泌物增多A組7例,B組21例,A組出現(xiàn)率低于B組,有顯著差異(P0.05);A組低氧血癥發(fā)生2例,B組低氧血癥發(fā)生5例,兩組未見差異(P0.05);惡心嘔吐兩組均未發(fā)生。結(jié)論1.家長(zhǎng)陪伴下的麻醉誘導(dǎo)減輕了家長(zhǎng)的擔(dān)心和焦慮,使麻醉更人性化,其方式更易于被患兒和家長(zhǎng)接受,值得臨床推廣使用。2.組合式吸入麻醉誘導(dǎo)裝置制作方便,便于攜帶,將輸氧、輔助呼吸和吸入麻醉三者功能結(jié)合起來,解決小兒入室困難時(shí),效果明顯,不良反應(yīng)少,臨床應(yīng)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.
【學(xué)位授予單位】：安徽醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R726.1

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