瑞芬太尼与芬太尼静脉复合麻醉用于小儿唇腭裂整复术的对比观察

A comparison of remifentanil and fentanyl in children undergoing balanced anesthesia for cleft lip and palate repairing operation

目的 评价瑞芬太尼静脉复合异丙酚麻醉用于小儿唇腭裂整复术的可行性。方法 60例1～3岁唇腭裂患儿随机分为两组（n=30）：瑞芬太尼复合异丙酚组（R组）和芬太尼复合异丙酚组（F组），分别以瑞芬太尼复合异丙酚或芬太尼静脉复合异丙酚诱导及维持麻醉。采用大脑状态监测（Cerebra State Monitor，CSM）仪监测麻醉深度及清醒程度。观察并比较两组患儿诱导前（T1）、诱导时（T2）、手术即刻（T3）、手术20min（T4）及清醒拔管（T5）血流动力学变化；记录手术时间、清醒及拔管时间，并观察术后呼吸抑制、呕吐及躁动等不良反应。结果 两组患儿术中血液动力学稳定。R组与F组清醒时间分别为（5．5±2．1）min、（10．4±8．6）min，差异有统计学意义；两组均无严重不良反应发生。结论 瑞芬太尼静脉复合异丙酚麻醉用于小儿唇腭裂整复术优于芬太尼静脉复合异丙酚麻醉，可加快清醒时问及拔管时问，缩短手术室的滞留时间。

Objective To compare the the efficacy and safety of remifentanil and fentanyl in the children undergoing balanced anesthesia for cleft lip and palate repairing operation. Methods Sixty children with cheilopalatognathus aged 1-3 years were evenly randomised into the two groups （30 cases）, remifentanil one （group R） and fentanyl one （group F） . Anesthesia was induced and maintained by propofol and either remifentanil or fentanyl. Depth of anesthesia awake degree were recorded by Cerebra State Monitor during the anesthesia. Additionally, the haemodynamics changes were checked at different time point and adverse events such as respiratory depression,vomit and restlessness were observed. Results The haemodynamics conditions of the two groups were sta- ble. The average recovery time of remifentanil group was （5.5±2. l）min,and that of fentanyl group was （10.4±8.6）rain. There was significant difference between the two groups in terms of recovery time. No adverse events happened in both two groups. Conclusion Remifentanil can offer superior intraoperative hemodynamic stability in comparison with fentanyl, and has no compromising recovery from anesthesia. Because of its superiority in shortening the time to awake and extubate, remifentanil is more suitable for anesthesia in cleft lip and palate repairing operation.