瑞芬太尼用于小儿先天性腭裂修补术的临床观察

Clinical observation of remifentanil in anesthesia in children with cleft palate undergoing repair operation

目的：观察瑞芬太尼对先天性腭裂修补术患儿血流动力学和血管紧张素Ⅱ的影响。方法：选择ASA（美国麻醉医师协会分级法）Ⅰ～Ⅱ级先天性腭裂修补手术患儿50例，患者年龄3．5～13岁。随机分为瑞芬太尼组（R组）和芬太尼组（F组），各25例。入手术室后均肌注氯胺酮4～10mg／kg。麻醉诱导：试验组用瑞芬太尼2μg／kg，异丙酚1～2mg／kg；对照组用芬太尼2．5μg／kg，异丙酚1～2mg／kg，2组肌松剂均用维库溴铵0．1mg／kg，经鼻气管插管。麻醉维持：试验组用瑞芬太尼、异丙酚持续泵注，对照组用芬太尼、异丙酚持续泵注。2组均间断静脉注射维库溴铵维持肌松。术中连续监测ECG，HR，BP，SpO2．；分别于手术前1d（T1），气管插管时（T2），手术开始后10min（T3），气管拔管后5min（T4）自静脉采血，检测血浆血管紧张素Ⅱ（AgⅡ）水平；记录麻醉时间，苏醒时间和拔管时间。结果：与T1比较2组他、T3时HR，SBP，DBP和AgⅡ水平均降低（P〈0．05）；2组间他、T3时HR、SBP、DBP、SpO2，血管紧张素Ⅱ水平均无显著差异；麻醉时间R组长于F组，术后苏醒和拔管时间R组显著短于F组（P〈0．01）。结论：瑞芬太尼比芬太尼镇痛作用强，能更有效抑制先天性腭裂患儿手术中的应激反应，维持术中血流动力学稳定，并且术后苏醒快，拔管时间短。

Objective：To observe the effects of remifentanil on hemodynamics and plasma angiotentratin-Ⅱ （Ag Ⅱ） level in children with cleft palate undergoing repair operation. Methods.Fifty patients, ASA I - Ⅱ, were randomly divided into two groups,remifentanil group （R group） and fentanyl reoup （F group）. Patients in R group received remifentanil combined with propofol anesthesia, those in F group received fentanyl combined with propofol anesthesia. Vecuronium bromide was given as muscle relaxant in both groups. ECG, HR, BP and SpO2 were monitored in all the patients during operation,and peripheral venous blood samples were taken 1 d before operation（ T1 ）, at the time of endotracheal i ntubation（ T2 ）, l0 min after operation beginning （33）, 5 minutes after extubation （T4） for the check of plasma Ag Ⅱ level. Results：At T2 and T3 HR, SBP, DBP and plasma Ag Ⅱ level were significant lower in both group of the patients （ P 〈 0.05 ） ; there was no significant difference between the two groups at T2 and 33 in HR, SBP, DBP, SpO2 and Ag Ⅱ level. The anesthesia time was significantly longer in R group than that in F group（ P 〈 0.05 ） ; the recovery time and extubation time were significantly shorter in R group than that in F group （ P 〈 0.05 ）. Conclusion： Remifentanil is better than fentanyl for stabilizing hemodynamics, decreasing the stress responses, reducing the time of recovery and extubation of the general anesthesia in children with cleft palate undergoing repair operation.