瑞芬太尼与七氟醚在小儿腹腔镜疝囊高扎术中的麻醉效果比较

Comparison of the Efficacy of Anesthesia with Remifentanil vs Sevoflurane for Laparoscopic High Ligation ofHernia Sac in Children

【目的】比较小儿腹腔镜疝囊高扎术中瑞芬太尼与七氟醚的麻醉效果。【方法】行择期腹腔镜疝囊高扎术患儿80例，AsAI级，年龄1～6岁，体重9～22k，随机分为瑞芬太尼幼儿（1～3岁）组（R1组）和瑞芬太尼学龄前儿童（3～6岁）组（R2组）、七氟醚幼儿（1～3岁）组（S1组）和七氟醚学龄前儿童（3～6岁）组（s2组），每组20例。麻醉诱导：R1、R2组微量注射泵泵入瑞芬太尼1μg／（kg·min）；S1、S2组高流量吸入8％七氟醚，四组诱导后均置入喉罩。麻醉维持：R1、R2组瑞芬太尼0．1～1／μg／（kg·min）；s1、s2组持续吸入2％～6％七氟醚，术中患儿保留自主呼吸。四组均于手术结束前5min停药。记录患儿不同时间点的平均动脉压（MAP）、心率（HR）、脉搏血氧饱和度（SpO2）、呼吸频率（RR）、肺潮气量（VT）等指标，观察患儿诱导期不良反应、术中肢体活动的情况、苏醒期躁动情况及其他不良反应。【结果】四组惠几术中麻醉平稳，无肢体活动，MAP、HR变化无统计学差异（P〉0．05），R1组有4例、R2组有3例在麻醉诱导时出现呼吸抑制，予辅助呼吸后恢复。S1、S2组诱导时间较R1、R2组缩短，苏醒时间较R1、R2组长，R1组麻醉维持时SpO2、RR、VT较S1组降低，R2组麻醉维持时sp02、RR较S2组降低。S1、S2组拔喉罩时喉痉挛各1例，苏醒期躁动R1、R2组发生率较S1、S2组高，术后恶心呕吐等其他不良反应的发生率无明显差异。【结论】瑞芬太尼与七氟醚在小儿腹腔镜疝囊高扎术中的麻醉效果均较好，两种麻醉方法各有其相对优势。

[Objective]To compare the efficacy of anesthesia with remifentanil vs sevoflurane for laparoscopic high ligation of hernia sac in children. [Methods] Eighty ASA I pediatric patients（aged 1-6 years old, weighed 9-22kg） undergoing elective laparoscopic hernia sac high ligation were randomly divided into 4 groups with 20 cases in each including infant（l-3 years old） with remifentanil group（group R1）, preschooler（3-6 years old） with remifentanil group（group R2）, infant（1 - 3 years old） with sevoflurane group （group S1） and preschooler（3- 6 years old）＂ with sevoflurane group（group S2）. In group R1 and R2, anesthesia was induced and maintained with trace injection pump of remifentanil 1 μg/（kg -rain） during induction and 0. 1-1 btg/（kg · min） during maintenance of anesthesia, respectively. In groupS1 and $2, anesthesia was induced with 8% sevoflurane and maintained with 2%-6% sevoflurane. Each group was placed with the laryngeal mask and retained spontaneous breathing after induction. The drug was stopped at 5min before operation in all groups. The mean arterial pressure（MAP）, heart rate（HR）, SpO2, respiratory rate（RR） and tidal volume（TV） at different time points were recorded. The adverse reactions during induction, intraoperative limb movements, restless state during revival and other side effects were observed. [Results] The anesthesia was smooth without limb movements in all groups, and there was no significant difference in MAP and HR among all groups（ P 〉0. 05）. Respiratory inhibition occurred in 3 cases in group R1 and 4 cases in group R2 who were recovered after auxiliary breathing. The induction time in group S1 and S2 was less than that in group R1 and R2, but the conscious time in group S1 and S2 was more than that in group R1 and R2. SpO2, RR and TV in group R1 during maintenance of anesthesia were lower than those in group S1, and SpOz and RR in group R2 were lower than those in group S2. Laryn- gospasm occurred in 2 cases in group S1 and S2 when pulling laryngeal mask out. The incidence of restless state during revival in group R1 and R2 was higher than that in group S1 and S2. There was no significant difference in the other complications such as nausea and vomiting among all groups. [Conclusion]Both remifentanil and sevoflurane for laparoscopic high ligation of hernia sac in children have good anesthesia effect. Each anesthesia method has its advantage and disadvantage.