摘要:目的:定量測定50 %小兒在喉罩表面涂抹丁卡因膠漿的情況下平穩拔除喉罩時呼氣末七氟烷濃度。方法:25例擇期行四肢及體表手術的患兒,高流量吸入七氟烷誘導并以七氟烷和氧化亞氮維持麻醉,不使用肌肉松弛劑及靜脈麻醉藥物,手術結束后停止吸入氧化亞氮,并維持設定的七氟烷濃度10min后拔除喉罩。根據Dixon序貫法確定喉罩拔除時的七氟烷濃度,每0.1 Vol%七氟烷為1個增減單位。患兒未出現咳嗽、牙關緊閉、體動、屏氣及喉痙攣則認為拔除喉罩平穩。結果:50 %小兒平穩拔除喉罩時呼氣末七氟烷濃度(EC50)為1.22 Vol%(95 %的置信區間分別為0.99 Vol%～1.49 Vol%)。結論:在喉罩表面涂抹丁卡因膠漿的情況下,3～8歲患兒喉罩滿意拔除時呼氣末七氟烷EC50值為1.22 Vol%。Abstract: Objective: To determine the concentration of sevoflurane where 50%( EC50 ) of the attempts to remove the laryngeal mask airway (LMA ) with the Teracainum Gel would be successful in children. Methods: Twentyfive nonpremedicated children, aged 38 years old, ASA physical status I, scheduled for extremities or peripherical surgery were enrolled in this study. General anesthesia was induced with sevoflurane and maintained with sevoflurane and nitrous oxide in oxygen. After the surgery, the target concentration was maintained for at least 10 min, and then the LMA was removed. Each target concentration was predetermined by the Dixon’s upanddown method (with 0.1 Vol% as a step size), starting at 1.20 Vol% concentration of sevoflurane. A removal accomplished without coughing, teeth clenching, gross purposeful movement, breath holding or laryngospasm, during or within 1 min after removal was considered to be successful. Results:The concentration of sevoflurane to achieve successful LMA removal in 50% of children was 1.22 Vol% (95%CL, 0.99 Vol%1.49 Vol%). Conclusion: The EC50 value of sevoflurane for LMA smooth extubation in children aged 38 years old with teracainum gel was 1.22 Vol%.
目的 探討麻醉藥物（揮發性麻醉藥或靜脈麻醉藥）與成人體外循環下心臟手術患者術后感染發生風險的關系。方法 回顧性分析2019年6月—2020年6月四川大學華西醫院496例擇期行成人體外循環下心臟手術患者的臨床資料，其中女251例、男245例，平均年齡（54.1±11.4）歲。美國麻醉醫師協會分級Ⅰ～Ⅲ級。根據麻醉藥物，將患者分為兩組：以七氟烷或地氟烷為主的吸入麻醉組243例，以丙泊酚為主的靜脈麻醉組253例。主要結局指標：術后30 d內感染發生率，包括肺部感染、手術部位感染、膿毒血癥和泌尿系統感染。次要結局指標：術后機械通氣時間、再次氣管插管率、ICU停留時間、術后住院時間、住院總費用。結果 共155例（31.3%）患者發生了術后30 d內感染，吸入麻醉組發生率32.9%，靜脈麻醉組發生率29.6% ，差異無統計學意義［RR=1.111，95%CI（0.855，1.442），P=0.431］。兩組次要指標差異無統計學意義（P>0.05）。結論 術中麻醉維持藥物（揮發性麻醉藥或靜脈麻醉藥）的選擇，不影響成人體外循環下心臟手術患者術后感染的發生風險。