CHAQALOQLAR EZOFAGOPLASTIKASIDA OPIOIDSIZ ANESTYEZIYA: ULTRATOVUSH NAVIGATSIYALI ESP-BLOKADA USULINING YANGI IMKONIYATLARI
Abstrakt
Zamonaviy pediatrik anesteziologiyaning rivojlanish bosqichida chaqaloqlarda o‘tkaziluvchi tashrixlarning anesteziologik ta’minotida multimodal anesteziya komponenti sifatida regional anesteziya/analgeziya usullarini takomillashtirish masalalari dolzarb bo‘lib xisoblanmoqda. Taqiqot maqsadi. Chaqaloqlarda ezofagoplastika operatsiyasining anesteziologik ta’minotida ultratovush navigatsiyali ESP-blokadaning samaradorligi va uning klinik amaliyotdagi qo‘llanish imkoniyatlarini baholash. Tadqiqot materiali va usullari. Qizilo ‘ngach atreziyasi aniqlangan 32 nafar chaqaloqlarda ESP-blokada texnikasi taklif qilingan va umumiy anesteziya komponenti sifatida regionar anesteziyaning ushbu turi bilan opioidli umumiy anesteziya usuli samaradorligi operatsiyadan keyingi davrda ekstubatsiya va ventilyatsiya muddati va analgeziya darajasiga ko‘ra qiyosiy taxlil qilingan. Har ikki guruhda ham gemodinamik va repirator monitoring amalga oshirilgan. Tadqiqot natijalari. Asosiy guruhdagi yetuk chaqaloqlarning 15 tadan atigi 2 tasi (6,25%) operatsiyadan keyingi uzoq muddatli ventilyatsiyaga muxtoj bo‘lgan bo‘lsa, opioidli umumiy anesteziya o‘tkazilgan chaqaloqlarning 40,6% ida extiyoj kuzatilgan. Chala tug‘ilgan chaqaloqlarning sun’iy o‘pka ventilyatsiyasiga extiyoji har ikki guruhda ham kuzatilgan va mos ravishda 15,6% va 3,12% ni tashkil qildi. Regionar anesteziya qo‘llanilgan yetuk chaqaloqlar (n=8; 25,0%) qiyosiy guruhga (n=3; 9,37%) nisbatan ertaroq ekstubatsiya qilingan va bu statistik ishonchli farqlanishga ega bo‘lgan (p<0,05). Umumiy anesteziya bilan ESP-blokada qo‘llanilgan muddatiga yetib tug‘ilgan chaqaloqlarda ekstubatsiyagacha bo‘lgan o‘rtacha vaqt 1 soat 20 daqiqani (±0,95) tashkil qilgan bo‘lsa, ushbu ko‘rsatkich opioidlar qo‘llanilgan chqaloqlar guruhida 3 soat 40 daqiqagacha (±1,25) yetdi (P<0,001). Chala tug‘ilgan chaqaloqlarda traxeya ekstubatsiyasi regionar anesteziya qo‘llanilgan guruhda o‘rtacha 6 soat 20 daqiqada (±2,75) bajarilgan bo‘lsa, opioidlar qo‘llanilgan guruh chaqaloqlarida 12 soat 80 daqiqadan 3 sutkagacha amalga oshirildi va bu ko‘rsatkichlar statistik jixatdan ishonchli farqlanishga ega bo‘ldi (P<0,001). Xulosa. Qizilo‘ngach atreziyasi bilan tashrix o‘tkazilgan chaqaloqlarda multimodal anesteziya komponenti sifatida ultratovushli navigatsiya bilan o‘tkaziluvchi ESP-blokadaning qo‘llanilishi xavfsiz, texnik jixatdan bajarilishi oson bo‘lib, operatsiya paytida va undan keyingi davrda og‘riqni boshqarish imkonini beradi, shuningdek, operatsiyadan keyin chaqaloqlarni erta tiklanishini ta’minlaydi, uzoq muddatli sun’iy o‘pka ventilyatsiyasiga extiyojni kamaytiradi.
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