全凭静脉麻醉在小儿扁桃体切除术中的应用

A clinical study of TIVA in children undergoing tonsillectomy

目的 探讨瑞芬太尼复合丙泊酚全凭静脉麻醉在小儿扁桃体切除术中的麻醉可行性，与吸入麻醉方法比较对小儿术后苏醒和意识状态的影响。方法 选择30例ASAⅠ～Ⅱ级拟行咽扁刮除双侧腭扁桃体切除术的小儿，随机分为R组和I组，每组15例。麻醉诱导：R组静注咪唑安定0．05mg／kg，丙泊酚1～1．5mg／kg，维库溴铵0．1mg／kg，瑞芬太尼1．0μ／kg。I组静注氯胺酮1～2mg／kg，咪唑安定0．05mg／kg，维库溴铵0．1mg／kg。麻醉维持：R组瑞芬太尼每小时6～12μg/kg复合丙泊酚4～6mg／kg静脉持续输注。I组吸入异氟烷维持麻醉。观察两组病人术前、术中、术后的SpO2、呼吸次数、SBP、DBP、心率，术后呼吸恢复、清醒时间，及术后拔管5min的OAAS评分。记录有无术中知晓、术后疼痛，以及恶心、呕吐、躁动等不良反应。结果 两组SpO2、RR、术前、术中及术后血压、心率无显著差异（P〉0．05），术后呼吸恢复及清醒时间R组均少于I组，有显著差异（P〈0．05）。两组清醒时间有显著性差异（P〈0．05）。R组术后拔管5min的OAAS评分比I组高，有显著性差异（P〈0．05）。术后R组苏醒平稳无躁动，I组有9例躁动。结论 瑞芬太尼复合丙泊酚全凭静脉麻醉可以安全地应用于小儿扁桃体切除术。瑞芬太尼复合丙泊酚全凭静脉麻醉较吸入麻醉术后清醒迅速、恢复质量好。

Objective To investigate the feasibility of TIVA with remifentanil/propofol and the effects on post- operative recovery and conscious state incomparison with inhalational anesthesia in children undergoing tonsillectomy. Methods Thirty ASA physical status Ⅰ and Ⅱ patients undergoing elective tonsillectomy surgery were included. Patients were randomly divided into two groups ： group R and group I （ n = 15） ： group R patients received induction with midazolam 0.05 mg/kg, propofol. 1 - 1.5mg/kg, vecuronium 0. 1mg/kg and remifentanil 1.0mg/kg intravenously（ Ⅳ ）. The group Ⅰ received induction with ketamine 1.0mg/kg, midazolam 0.05mg/kg and vecuronium 0. 1mg/kg Ⅳ. The anesthesia was continued with a continuous infusion of remffentanil 6 - 12mg/kg per hour and propofol 4 - 6mg/kg in group R. Maintenance of group I was obtained with isoflurane. The following parameters were monitored： SpO2, RR, SBP, DBP, HR before administration of anesthesia; during the operation and postoperation, recovery time of respiratory, time of eye opening, conscious state （OAAS score） 5min after extubation. Postoperative interview includes adverse reactions, intraoperative awareness, pain, nausea, vomiting and restlessness. Results There was no significant difference in SpO2, RR, SBP, DBP and HR before administration of anesthesia, during the operation and postoperation between the two groups. Recovery time of respiratory and time of eye opening in group R were significantly earlier than those in group I （ P 〈 0.05）. Compared to group I , OAAS score in group R was higher significantly （ P 〈 0.05 ）. During wake-up period no patient has restlessness in group R, 9 out of 15 children has restlessness in group I （P 〈 0.05 ）. Conclusion TIVA with propofol/remifentanil can be applied safely in pediatric tonsillectomy surgery. Compared to isoflurane anesthesia, Postoperative recovery of TIVA with propofol/remifentanil is earlier and better.