Abstract: Objective　To observe the effect of sevoflurane inhalation via the combined inhalation anesthesia induction device (CIAI) in emergency manual reduction of humeral supracondylar fracture in children. Methods　This was a control trial. Eighty-one children with humeral supracondylar fracture took manual reduction in Emergency Department, Hospital of 73th Army Group of Land Force from July 2015 to May 2020,including 42 males and 39 females, and they were 2 to 5 (3.24±1.71) years old. The patients were divided into a CIAI Group (42 cases) and a control group (39 cases). Before the manual reduction, the CIAI group were given sevoflurane 2-5 ml/time by the combined inhalation anesthesia induction device, while the control group were given propofol 3-4 mg/kg intravenously. Before (T1) and during (T2) the manual reduction and when the children came to (T3), the heart rates, oxygen saturations (SpO₂), mean arterial pressures (MAP), Ramsay Sedation scores, The Face, Legs, Activity, Cry, Consolability Behavioral Tool (FLACC) scores, frequencies of adding drugs, and incidences of adverse reactions were statistically analyzed. The Shapiro-Wiktest test was used to evaluate the normality of the measurement data. The measurement data of normal distribution were expressed as (x±s), and were compared between the two groups by independent-sample t test. Results　At T1, there were no statistical differences in MAP, HR, and SpO₂ between the two groups (all P>0.05). The MAP, HR, and SpO₂ at T2 and T3 were (69.9±5.1) mmHg (1 mmHg=0.133 kPa) and (69.1±4.1) mmHg, (109.5±8.1) beats/min and (103.9±6.3) beats/min, and (98.9±0.7) mmHg and (98.9±0.8) mmHg in the control group, and were (69.1±5.8) mmHg and (69.5±5.1) mmHg, (93.6±2.9)  beats/min and (95.6±5.6)  beats/min, and (99.3±0.6) mmHg and (99.5±0.5) mmHg in the CIAI group, with lower fluctuations in the CIAI group (all P<0.05). There were no statistical differences in the Ramsay and FLACC scores between the two groups before and after the manual reduction (all P>0.05). The CIAI group fell asleep slower and recovered faster than the control group [(38.2±10.3) s vs. (24.2±4.5) s and (5.8±1.9) min vs. (20.1±4.5) min; both P<0.05]. The incidences of restlessness and increased oral secretion and the total incidence of adverse reactions in the CIAI group were lower than those in the control group (all P<0.05). Conclusion　Compared with the traditional intravenous administration of propofol, the inhalation of sevoflurane by the combined inhalation anesthesia induction device in children with humeral supracondylar fracture in the operation room has ideal clinical outcomes. It is more humanized in the application process, with ideal safety, more convenience, high comfort, low cost, and fewer adverse reactions. Therefore, it is suitable for further clinical application and promotion.

Key words: Humeral supracondylar fracture, Combined inhalation anesthesia induction device, Painless manual reduction, Sevoflurane, Children

摘要： 目的　观察组合式吸入麻醉诱导（combined inhalation anesthesia induction，CIAI）装置吸入七氟醚在急诊儿童肱骨髁上骨折手法复位的应用效果。方法　本研究为对照试验。2015年7月至2020年5月于陆军第七十三集团军医院急诊科就诊的需行手法复位的儿童肱骨髁上骨折患儿81例，其中男42例、女39例，年龄2～5（3.24±1.71）岁。将患者分为CIAI组（42例）与对照组（39例）。CIAI组在行手法复位前采用CIAI装置吸入七氟醚2～5 ml/次，对照组则采用传统静脉注射丙泊酚3～4 mg/kg。统计并分析两组患儿手法复位前（T1）、手法复位时（T2）、患儿苏醒时（T3）的心率（HR）、血氧饱和度（SpO₂）、平均动脉压（MAP）、Ramsay镇静评分、儿童疼痛行为量表（FLACC）评分、追加药物次数以及不良反应发生率等指标。采用Shapiro-Wiktest检验评估计量资料的正态性。正态分布的计量资料用（x±s）表示，组间比较采用独立样本t检验。结果　T1时，两组MAP、HR、SpO₂比较，差异无统计学意义（均P>0.05）；与对照组［MAP（69.9±5.1）mmHg（1 mmHg=0.133 kPa）、（69.1±4.1）mmHg，HR（109.5±8.1）次/min、（103.9±6.3）次/min，SpO₂（98.9±0.7）mmHg、（98.9±0.8）mmHg］相比，CIAI组T2、T3时MAP［（69.1±5.8）mmHg、（69.5±5.1）mmHg］、HR［（93.6±2.9）次/min、（95.6±5.6）次/min］、SpO₂［（99.3±0.6）mmHg、（99.5±0.5）mmHg］波动较小（均P<0.05）。两组患儿手法复位前后Ramsay、FLACC评分差异均无统计学意义（均P>0.05）。与对照组相比，CIAI组入睡慢［（38.2±10.3）s比（24.2±4.5）s，P<0.05］，苏醒时间短［（5.8±1.9）min比（20.1±4.5）min，P<0.05］，且躁动、口腔分泌物增多发生率及不良反应总发生率低于对照组（均P<0.05）。结论　对比传统的静脉注射丙泊酚的给药方式，手术室外急诊儿童肱骨髁上骨折手法复位时采用组合式吸入麻醉诱导装置吸入七氟醚具有较理想的临床效果。其在运用过程中更人性化，具有安全性高、更便捷、舒适度高、费用低、不良反应少等特点，适合临床运用与推广。

关键词: 肱骨髁上骨折, 组合式吸入麻醉诱导装置, 无痛手法复位, 七氟醚, 儿童