瑞芬太尼复合丙泊酚麻醉在小儿气管异物取出术中的应用

Evaluation of propofol-remifentanil total intravenous anaesthesia in children undergoing tracheal foreign body removal

目的研究瑞芬太尼在小儿气管异物取出术麻醉中的临床效果及安全性。方法选择美国麻醉学会制定的Ⅰ～Ⅱ级标准、年龄2～4岁、行气管异物取出术小儿40例，随机分为观察组和对照组，每组20例。观察组静脉注射丙泊酚3mg／kg诱导麻醉，术中维持丙泊酚1．5mg／（kg·h）微泵注入及瑞芬太尼0．05μg／（kg·min）持续泵注。对照组静脉注射γ-羟丁酸钠90mg／kg诱导麻醉，术中麻醉深度不足时分次静注氯胺酮1．5mg／kg至麻醉满意，并根据手术需要分次追加氯胺酮1mg／kg。记录诱导前（T0），插支气管镜后（T1），拔支气管镜时（T2），清醒时（T3）各时间收缩压、舒张压、心率及动脉血氧饱和度。观察两组苏醒时间，对比两组患儿拔管后上呼吸道梗阻或屏气、苏醒期躁动、术后恶心呕吐的发生率。结果两组T1与T2时血流动力学变化比较，舒张压差异无显著性（P〉0．05），其他血流动力学指标变化差异有显著性（P〈0．05）；观察组患儿气管异物取出术中血流动力学相对平稳，而对照组患儿血流动力学变化较大。瑞芬太尼起效迅速，恶心呕吐、苏醒期躁动、支气管痉挛和术后舌后坠的发生较对照组少。苏醒时间短，而且苏醒效果佳，与对照组相比差异有显著性（P〈0．05）。结论瑞芬太尼、丙泊酚复合静脉麻醉可安全有效地用于小儿气管异物取出术，并具有血流动力学稳定、手术麻醉患儿苏醒时间短和苏醒质量高的优点。

Objective To study the clinical efficacy and safety of remifentanil anesthesia in tracheal foreign body removal. Methods Forty patients aged from 2 to 4 years and admitted for tracheal foreign body removal, ASA Ⅰ-Ⅱ, were randomly divided into two groups, remifentanil group （n = 20）and control group （n = 20）. For the remifentanil group, propofol （3 mg/kg） was used for induction of anesthesia and a combination of remifentanil [ 0.05 μg/（kg· min） ] and propofol [ 1.5 mg/（kg·h） ] was administered continuously for anesthesia maintenance by micro-pump; while the control group were given anaesthetic induction with sodium oxybate （90 mg/kg） and maintenance with intravenous bolus of ketamine. SBP, DBP, HR and SaO2 were monitored in both groups before operation （T0）and at the time point of bronchial endoscopy （T1）, endoscope removal （T2）, consciousness recovery （T3）. The incidence of post-operative agitation, nausea and vomiting were recorded. Results Except diastolic blood pressure, other hemodynamic parameters at T1 and T2 showed significant difference between the two groups（ P 〈 0.05 ）. There was less circulatory fluctuation, faster recovery with lower incidence of post-operative complications in the remifentanil group than in the control group（P 〈 0.05）. Conclusion Remifentanil can be used safely and effectively in total intravenous anaesthesia of children undergoing tracheal foreign body removal.